Validity Of Rating Scale Research Articles

Identifiying Autism Spectrum Disorders (ASD) in School Children for Placement Using a Valid Screening Instrument in Nigeria

The purpose of the study was the use of an adapted valid Childhood Autistic Rating Scale (CARS) to identify Autism Spectrum Disorders (ASD) in school children for the purpose of placement and intervention in a special school that comprised categories of children with intellectual disabilities. Samples of 52 subjects randomly selected from the population of 138 were used to rate their behaviours using the CARS. Using nonexperimental research design of cross-categorical survey (descriptive research) was considered most suitable for the study. This is a survey that studies a group of sample in order to identify traits of such group. With the use of statistical data of chi-square, scores collected from the participants revealed that there was no significant difference in the scores or ratings. Also, the result obtained from the use of t-test indicated that the instrument significantly differentiate ASDs traits from Non-ASDs. The findings in this study prompted a suggestion that special schools, centres, homes etc should get this valid instrument handy for the purpose of identifying autistic traits in school children for correct placement and intervention.

Taking care of our future doctors: a service evaluation of a medical student mental health service

BackgroundStudies suggest medical students experience high levels of mental distress during training but are less likely, than other students, to access care due to stigma and concerns regarding career progression. In response, The School of Clinical Medicine, University of Cambridge supported the development of the ‘Clinical Student Mental Health Service’ to provide specialist input for this vulnerable group. This study evaluates the efficiency and effectiveness of this service.MethodsUsing mixed-methods, cross-sectional analysis of validated psychiatric rating scales and qualitative feedback, 89 responses were analysed from 143 clinical students referred, between 2015 and 2019. The care pathway included initial review by a psychiatrist, who triaged students to psychologists delivering therapies including: Cognitive Behavioural Therapy, Interpersonal Therapy, Eye Movement Desensitization Reprocessing Therapy or Cognitive Analytic Therapy.Efficiency was assessed by waiting times for psychiatry and psychology interventions, and number of sessions. Academic outcomes included school intermission and graduation. Clinical effectiveness was analysed by measuring global distress, depression, anxiety, functioning and suicidal risk. Pre/post intervention changes were captured using t-test and McNemar test with thematic analysis of qualitative feedback.ResultsReferral rates increased from 3.93% (22/560) in 2015 to 6.74% (45/668) in 2018. Median waiting times for initial psychiatric assessment and start of therapy was 26 and 33 days, respectively. All graduating students moved on to work as junior doctors.Levels of distress, (t = 7.73, p < 0.001, df = 31), depression (t = 7.26, p < 0.001, df = 34) anxiety (Z = − 4.63, p < 0.001) and suicide risk (Z = − 3.89, p < 0.001) were significantly reduced. Participant’s functioning was significantly improved (p < 0.001, 99.5% CI 4.55 to 14.62). Feedback indicated high satisfaction with the rapid access and flexibility of the service and the team clinicians.ConclusionsA significant proportion of medical students attending the service scored highly on validated rating scales measuring emotional distress, suicidality and mental illness. Reassuringly they benefitted from timely specialist mental health input, showing improvements in mental well-being and improved functioning. The development and design of this service might serve as an exemplar for medical schools developing similar support for their students.

The role of executive functioning on the intention-behaviour relationship of health behaviours: a temporal self-regulatory perspective

Objective The current study employed the Temporal Self-Regulation theory (TST) to determine if self-regulatory capacity and prepotent behaviour moderate the relationship between intention and health behaviours (i.e., physical activity, and healthy eating) in college students. Design 220 students were surveyed across two time points to assess past/intended behaviour (Time 1) and follow-up behaviour (Time 2). Main Outcome Measures To address limitations in previous research, self-regulatory capacity was assessed using an ecologically valid rating scale (Barkley Deficits in Executive Functioning Scale). Multi-item assessment measures were utilised for physical activity (International Physical Activity Questionnaire) and healthy eating (All-Day Screener) behaviours. Results A link between intention and follow-up behaviour was established and executive functioning (EF) and past behaviours were positively associated with follow-up behaviour. EF had no unique moderation effects on health behaviours, but combinations of Low, Moderate, and High levels of past behaviour and EF demonstrated moderation for physical activity and healthy eating. Conclusion This study demonstrated the utility of the TST in predicting health behaviour and emphasised the mutual necessity of EF and past behaviour in understanding the intention-behaviour relationship. Findings can be used to formulate studies and interventions that reduce barriers to health behaviours, therefore, lessening the need for high self-regulatory abilities.

How well do elderly patients with major depressive disorder respond to antidepressants: a systematic review and single-group meta-analysis

BackgroundDepression is one of the leading causes of the global burden of disease, and it has particularly negative consequences for elderly patients. Antidepressants are the most frequently used treatment. We present the first single-group meta-analysis examining: 1) the response rates of elderly patients to antidepressants, and 2) the determinants of antidepressants response in this population.MethodsWe searched multiple databases for randomized controlled trials on antidepressants in the elderly with major depressive disorder above 65 years (last search: December 2017). Response was defined as 50% improvement on validated rating scales. We extracted response rates from studies and imputed the missing ones with a validated method. Data were pooled in a single-group meta-analysis. Additionally, several potential moderators of response to antidepressants were examined by subgroup and meta-regression analyses.ResultsWe included 44 studies with a total of 6373 participants receiving antidepressants. On average, 50.7% of the patients reached a reduction of at least 50% on the Hamilton Depression Scale (HAMD). Subgroup and meta-regression analyses revealed a better response to treatment for patients in antidepressant-controlled trials compared to placebo-controlled trials. Mean age, study duration, percentage of woman, severity of illness at baseline, dose of antidepressants in fluoxetine equivalents, year of publication, setting (in- or out-patients), antidepressant groups (SSRI, TCA, SSNRI, α2-antagonist, SNRI, MAO-inhibitor), ITT (intention-to-treat) analysis vs completer analysis, sponsorship and overall risk of bias were not significant moderators of response.ConclusionsOur findings suggest an improvement in symptoms can be found in about 50% of the elderly with major depressive disorder treated with antidepressants.

Das Delir beim idiopathischen Parkinson-Syndrom

The development of delirium in patients with idiopathic Parkinson's disease (IPD) is afeared complication, which is often associated with sustained worsening of motor symptoms and psychopathological sequelae. Little is known regarding the prevalence and incidence rates, course and prognosis. Clinical studies from which recommendations for evidence-based management of delirium in IPD can be derived are lacking. To summarize the state of the art regarding epidemiological and clinical features of delirium in IPD. Discussion of prevention strategies and non-pharmacological and pharmacological treatment options. A literature search was carried out in PubMed. The IPD is an independent risk factor for the development of delirium. Patients with IPD show poorer clinical outcome frequently with cognitive worsening and motor complications following development of delirium. So far no validated rating scales for recognition and course evaluation of delirium in IPD are available. Preventive strategies and non-pharmacological measures should be consistently implemented to improve management. There are insufficient data concerning pharmacotherapy with quetiapine and clozapine, whereas other neuroleptics are contraindicated for delirium in IPD due to antidopaminergic side effects.

Check the effects: systematic assessment of antipsychotic side-effects in an inpatient cohort.

Background:Antipsychotics are associated with a range of side-effects that can influence patients’ subjective well-being negatively resulting in poor adherence. In order to limit the negative consequences of side-effects, they should be regularly systematically assessed. The aim of this study was to systematically assess antipsychotic side-effects in an inpatient cohort using validated rating scales.Methods:Eligible individuals prescribed an antipsychotic for at least 2 weeks were invited to have their side-effects assessed systematically.Results:A total of 208 individuals were assessed systematically for antipsychotic side-effects; 71.5% (n = 138) stated that they had not reported side-effects to their clinician prior to the assessment. The most commonly reported side-effects were daytime drowsiness (75%), dry mouth (58.2%) and weight gain (50.0%), while the most distressing side-effects reported were erectile dysfunction (35.0%), sexual dysfunction (26.3%) and amenorrhoea (26.3%). There was no evidence of an association between side-effect severity/number of side-effects reported/distress caused by those taking high dose/combination antipsychotics versus standard dose monotherapy.Conclusion:Side-effects must be regularly and systematically assessed using a validated rating scale. As distress caused by side-effects plays a major role in non-adherence, assessment should examine distress and data on distressing side-effects should be available to those choosing an antipsychotic. Given the lack of correlation between high dose/combination antipsychotics and side-effects, treatment should be tailored to the individual based on response/tolerance and dose reduction/avoidance of polypharmacy should not be recommended to minimise side-effects.

Multirater assessment of young children's social and emotional learning via the SSIS SEL Brief Scales – Preschool Forms

Interest in social and emotional learning (SEL) skills is growing rapidly with all 50 states adopting SEL standards for preschool children. However, data on these types of skills for young children are limited due to a paucity of psychometrically-sound assessments. Further, most available assessments are lengthy and minimally aligned with widely used SEL frameworks such as the model proposed by the Collaborative for Academic, Social, and Emotional Learning (CASEL). Thus, the current study focused on the development of valid and time-efficient rating scales of young children's SEL skills using teachers and parents as informants. We used item response theory to select items from the SSIS Social Emotional Learning Edition (SSIS SEL; Gresham & Elliott, 2017) using the national standardization sample of the measure. We then examined initial evidence of score reliability, validity, and fairness for the SSIS SEL Brief Scales – Preschool Forms resulting from this process. Results provide initial evidence for score reliability, validity, and fairness for both the Teacher and Parent versions of this measure.

Fatigue numeric rating scale validity, discrimination and responder definition in patients with psoriatic arthritis

ObjectivesThis study assessed the psychometric properties of the fatigue numeric rating scale (NRS) and sought to establish values for clinically meaningful change (responder definition).MethodsUsing disease-specific clinician-reported and patient-reported data from...

Integrated multidisciplinary assessment of cerebral stroke outcome after treatment in a comprehensive stroke unit

Objective – to explore the possibility of integral assessment of the stroke outcome and to develop a method of integral assessment of the stroke outcome after in-patient treatment on the level of impairment and and the level of activities of daily living, which were assessed using rating scales and indices.Materials and methods. The study was conducted at the Stroke Center (SC), Oberig’ multidisciplinary hospital division, which operates according to the principles of Comprehensive Stroke Unit. Patients with a cerebral stroke who were admitted to the SC in 2010–2018 were enrolled. The data of the participants were prospectively entered into a special database and included discharge assessments using 8 valid rating scales and indices. Cluster analysis methods (in particular Kohonen neural networks) were used to design the integral assessment. Statistical analysis of the values ​​of the rating scales and indices in the selected clusters was performed using the Kruskal–Wallis criterion, post hoc comparisons were made using the Dunn multiple comparison criterion.Results. 852 patients (42.5 % women and 57.5 % men, median age – 66.7 year) were enrolled. 81 % of patients were diagnosed with ischemic stroke, and 19 % had hemorrhagic stroke. According to the chosen method, it is necessary and sufficient to split the data into 4 clusters. All participants in the study according to their assessments at discharge using the set of selected measures could be assigned to one of 4 isolated clusters: K1 (n = 366), K2 (n = 93), K3 (n = 104) or K4 (n = 289). National Institutes of Health Stroke Scale, modified Rankin scale, Barthel Index, Berg Balance Scale та Functional Ambulation Classification were the most significant determinants of the patient cluster. For the 5 measures there have been significant differences (p &lt; 0.001) in the four clusters. The condition of the patients in K4 cluster was the best (p &lt; 0.05), whereas the patients in the K1 cluster were worse (p &lt; 0.05), and the condition of the patients in the clusters K2 and K3 was much worse (p &lt; 0.05) compared with the cluster K4.Conclusions. Based on the integrated assessments of neurological impairments and activities of daily living all of stroke patients could be assigned to one of four identified clusters. Detecting predictors of poor outcome after in-patient management may help to find ways to improve their prognosis.

Making it together: a service evaluation of creative families: an arts and mental health partnership

ABSTRACT Objective To evaluate a collaborative intervention between an art and health service. Method This two-year early intervention initiative was comprised of six, ten-week long interlinked artist-led workshop programmes for groups of parents and their children. The number of participants that completed the intervention was 36; however, data were only collected for 22 due to having hard-to-reach participants. This evaluation used a within-subjects repeated measures pre and post design using scores from validated rating scales. Feedback interviews were also carried out over the phone. Results There were significant decreases in parental depression (r = −.5), anxiety (r = −.54) and stress (r = −.58). Socio-emotional problems of the children significantly decreased (r = −.37), however the parents’ perception of competency slightly decreased but was not-significant. Despite this, parents’ perception of self-efficacy increased after the Creative Families intervention (r = .17). Interview data showed that parents’ sense of isolation decreased, increased their self-confidence and that they were able to utilise what they had learnt at home. Discussion The project’s impact is understood in the context of the participants’ personal and social circumstances, many were living with complex problems and seen as being hard to reach. The research indicates a need for inter-agency and preventative interventions.

Smartphone application supplements laparoscopic training through simulation by reducing the need for feedback from expert tutors

BackgroundSimulation training is a validated, highly effective tool for learning laparoscopy. Feedback plays a crucial role in motor skills training. We present an app to guide students during advanced laparoscopy simulation training and evaluate its effect on training. MethodsA smartphone(iOS)-app was developed. A group of trainees were randomized to use the app (YAPP) or not use the app (NAPP). We used blinded analysis with validated rating scales to assess their performance before and after the training. The number of requests for tutor feedback per session was recorded. Finally, the participants in the YAPP group completed a survey about their experience with the app. ResultsFifteen YAPP and 10 NAPP completed the training program. There were no statistically significant differences between their skills performance scores (P = .338). The number of tutor feedback requests in the YAPP and NAPP was of 4 (3–6) and 13 (10–14) (P < .001), respectively. All participants in the YAPP group found the app was useful. ConclusionThe use of a smartphone app reduces the need for expert tutor feedback without decreasing the degree of skills acquisition.

PDXK mutations cause polyneuropathy responsive to pyridoxal 5'-phosphate supplementation.

ObjectiveTo identify disease‐causing variants in autosomal recessive axonal polyneuropathy with optic atrophy and provide targeted replacement therapy.MethodsWe performed genome‐wide sequencing, homozygosity mapping, and segregation analysis for novel disease‐causing gene discovery. We used circular dichroism to show secondary structure changes and isothermal titration calorimetry to investigate the impact of variants on adenosine triphosphate (ATP) binding. Pathogenicity was further supported by enzymatic assays and mass spectroscopy on recombinant protein, patient‐derived fibroblasts, plasma, and erythrocytes. Response to supplementation was measured with clinical validated rating scales, electrophysiology, and biochemical quantification.ResultsWe identified biallelic mutations in PDXK in 5 individuals from 2 unrelated families with primary axonal polyneuropathy and optic atrophy. The natural history of this disorder suggests that untreated, affected individuals become wheelchair‐bound and blind. We identified conformational rearrangement in the mutant enzyme around the ATP‐binding pocket. Low PDXK ATP binding resulted in decreased erythrocyte PDXK activity and low pyridoxal 5′‐phosphate (PLP) concentrations. We rescued the clinical and biochemical profile with PLP supplementation in 1 family, improvement in power, pain, and fatigue contributing to patients regaining their ability to walk independently during the first year of PLP normalization.InterpretationWe show that mutations in PDXK cause autosomal recessive axonal peripheral polyneuropathy leading to disease via reduced PDXK enzymatic activity and low PLP. We show that the biochemical profile can be rescued with PLP supplementation associated with clinical improvement. As B6 is a cofactor in diverse essential biological pathways, our findings may have direct implications for neuropathies of unknown etiology characterized by reduced PLP levels. ANN NEUROL 2019;86:225–240

Exploring demoralization in end-of-life cancer patients: Prevalence, latent dimensions, and associations with other psychosocial variables.

Demoralization is an existential distress syndrome that consists of an incapacity of coping, helplessness, hopelessness, loss of meaning and purpose, and impaired self-esteem. It can affect cancer patients, and the Demoralization Scale is a valid instrument to assess it. The present study aimed to investigate the prevalence of demoralization in end-of-life cancer patients and its associations with the medical and psychosocial variables. In addition, the latent dimensions of demoralization emerging in this distinctive population were explored. The study is cross-sectional. The sample consisted of 235 end-of-life cancer patients with a Karnofsky performance status (KPS) lower than 50 and a life expectancy of a few weeks. For each patient, personal and medical data was gathered by a palliative physician and a set of validated rating scales, assessing demoralization, anxiety, depression, physical symptoms, pain, spiritual well-being, and dignity, was administered by a psychologist during the first consultation. Sixty-four participants (27.2%) had low demoralization, 50.2% (n = 118) had medium demoralization, and 22.6% (n = 53) had high demoralization. Factor analysis evidenced a five-factor solution that identified the following demoralization factors: Emotional Distress and Inability to Cope, Loss of Purpose and Meaning, Worthlessness, Sense of Failure, and Dysphoria. All the considered variables were associated with demoralization, except for pain, nausea, breathing problems, and sociodemographic and clinical variables. End-of-life cancer patients showed higher levels of demoralization than has been reported in other studies with advanced cancer. These data could suggest that demoralization could increase in proximity to death and with impaired clinical condition. In particular, the five demoralization dimensions that emerged could represent the typical concerns around which the syndrome evolves in end-of-life cancer patients. Finally, spiritual well-being could play a protective role with respect to demoralization.

Demoralization and associated features in an Italian sample of end-of-life cancer patients.

e23004 Background: Demoralization is an expression of cancer-related existential distress that emerges from feelings of loss and changes linked to a life-threatening clinical condition. It is characterized by subjective incompetence, sense of failure, hopelessness, loss of purpose/meaning and low self-esteem. The study aimed to explore prevalence, latent dimensions and associated features of demoralization in a sample of end-of-life cancer patients. Methods: Participants were recruited for a cross-sectional assessment. For each patient, demoralization, anxiety, depression, physical symptoms, pain, spiritual well-being, and dignity were evaluated through validated rating scales and personal and medical data were gathered by a clinician. Final sample consisted of 235 end-of-life cancer patients with a Karnofsky Performance Status (KPS) lower than 50 and a life expectancy of few weeks. Results: High levels of demoralization occurred in 22.6% (n = 53) of patients. Sixty-four participants (27.2%) had low demoralization and 50.2% (n = 118) had moderate demoralization. Emotional Distress and Inability to Cope, Loss of Purpose and Meaning, Worthlessness, Sense of Failure and Dysphoria were the five latent dimensions of demoralization emerged from the factor analysis. Demoralization was significantly associated with depression, anxiety, dignity, spiritual well-being and the physical symptoms except for nausea and breathing problems. Conclusions: Demoralization levels seem to be higher in this distinctive population than in advanced cancer patients. This could be due to the fact that end-of-life cancer patients are in a severe clinical condition and nearing death. The emerged demoralization dimensions could be five forms of expression of the existential distress typical of this illness phase. The considerable number of patients suffering from demoralization strengthen the need for psychological interventions in order to reduce the existential distress at the end of life, focusing on finding meaning and detecting spiritual concerns.

Smartphone Application Guides Laparoscopic Training Through Simulation and Reduces the Need for Feedback from Expert Tutors

Background: Simulation training is a validated, highly effective tool for learning laparoscopy. Feedback plays a crucial role in motor skills training. We present an app to guide students during advanced laparoscopy simulation training and evaluate its effect on training. Methods: A smartphone (iOS)-app was developed. A group of trainees were randomized to use the app (YAPP) or not use the app (NAPP). We used blinded analysis with validated rating scales to assess their performance before and after the training. The number of requests for tutor feedback per session was recorded. Finally, the participants in the YAPP group completed a survey about their experience with the app. Results: 15 YAPP and 10 NAPP completed the training program. There were no statistically significant differences between their skills performance scores (p=0.338). The number of tutor feedback requests in the YAPP and NAPP was of 4 (3-6) and 13 (10-14) (pi0.001), respectively. All participants in the YAPP group found the app was useful. Conclusion: The use of a smartphone app reduces the need for expert tutor feedback without decreasing the degree of skills acquisition.

Tremor in normal adults: A population-based study of 1158 adults in the Faroe Islands

There are virtually no population-based data on tremor in normal individuals. Using a population-based sample of 1158 normal adults ages 40–98 years in the Faroe Islands, we characterized the extent of normal action tremor across age and gender strata. Participants drew two Archimedes spirals with each hand, and tremor was systematically quantified by a senior movement disorder neurologist using a reliable and valid ordinal rating scale (ratings = 0–3). Tremor was nearly universal - 1145 (98.9%) participants had a total mean spiral score > 0. Older age was associated with more tremor (p < .001) and spiral scores were higher in males than females (p < .001). The proportion of individuals with a spiral rating ≥ 1.5 (i.e., more than mild tremor) was low (1.8% - 8.5%); however, this value reached 19.6% in left-hand spirals of males ≥70 years old. In this population-based study of more than one thousand normal adults, the vast bulk (i.e., 98.9%) had tremor on spiral drawing. In general, the tremor was mild. The proportion of individuals with tremor above the mild range varied across age and gender strata. These extensive data may be used as a gold standard for defining normal levels of tremor within adult populations.

Prevalence of Essential Tremor in the Faroe Islands: A Population-Based Study

Background: No studies of the prevalence of one of the most common movement disorders, essential tremor (ET), have been undertaken in the Faroe Islands. Given the potential for founder effects in the Islands, and the highly genetic nature of ET, the Faroe Islands provide a particularly interesting setting in which to study the prevalence of ET. Objective: To estimate the prevalence of ET and study its characteristics. Methods: We used a 2-phase, population-based design, screening 1,328 randomly selected Faroese individuals aged ≥40 years. A subsample of 282 individuals who had returned the spirals and questionnaire was selected to participate in an in-person clinical evaluation. Tremor was systematically quantified by a senior movement disorder neurologist with particular specialization in tremor using a reliable and valid clinical rating scale followed by the application of rigorous diagnostic criteria used by tremor investigators internationally. Results: The overall crude prevalence was 2.9%. The age-adjusted prevalence was 3.1%. There was an age-associated rise in prevalence; by age ≥70, prevalence reached 4.8%. Twenty six of 27 (96.2%) were previously undiagnosed. Conclusions: This is the first population-based study of the prevalence of ET in the Faroe Islands. The estimated prevalence was similar to studies using the same or comparable methodologies.

Efficacy and acceptability of antidepressants in patients with ischemic heart disease: systematic review and meta-analysis.

To assess the efficacy and acceptability of antidepressants in adults with ischemic heart disease (IHD). We gathered all available randomized-controlled trials comparing antidepressants versus placebo or other antidepressants in adults with IHD. The primary outcome was depressive symptoms at the study endpoint, as measured by validated rating scales. We pooled data in a meta-analysis using a random-effects model. The confidence in the estimates (or certainty of the evidence) was assessed using the GRADE approach. Antidepressants appeared to be more effective than placebo in reducing depressive symptoms (11 comparisons; 1685 participants; standardized mean difference -0.71, 95% confidence interval: -1.11 to -0.30; GRADE quality: moderate). This result was confirmed in the subgroup of serotonin selective reuptake inhibitors, and for the single drugs sertraline and citalopram, with a greater magnitude of effect and a higher quality of evidence for the former. No differences between antidepressants and placebo emerged in terms of acceptability and tolerability, quality of life, mortality, and cardiovascular events. Only two small head-to-head studies were identified. Sertraline is a reasonable first-line choice in patients with IHD and depression, whereas the role of citalopram as the first-line agent should be reconsidered.

Leisure participation in frail and pre-frail older adults: What do we know about their knowledge and motivation concerning the use of compensatory strategies?

This descriptive study aimed to determine whether frail and pre-frail seniors know about specific compensatory strategies that healthcare professionals believe would foster their engagement in leisure activities, and whether they are motivated to use these strategies. Knowledge and motivation toward compensatory strategies were assessed in 26 community-dwelling older adults (80+) with valid and reliable rating scales. Strategies such as Taking breaks and Changing the time of the activity were more likely to be known and motivating. Participants reported different levels of knowledge and motivation toward Using a walking aid, wheelchair loans, chauffeuring by others, and accessible parking permit. Using paratransit services was a strategy more likely to be unknown but motivating. Results will support the development of interventions that foster vulnerable older adults’ optimal participation in meaningful leisure activities. The findings may also have implications for social policy, underlying the need to promote awareness of adaptive and accessible compensatory strategies.

A corpus-based analysis of grammatical complexity as a measure of international teaching assistants’ oral English proficiency

Oral English proficiency is one among several crucial factors to help determine the eligibility of international teaching assistants (ITAs) for various tasks associated with teaching undergraduate students at U.S. universities. The oral English proficiency test (OEPT) is a test used to screen prospective ITAs whose TOEFL speaking scores were below the cutoff required for admission and to determine whether they need additional support courses. Drawing on previous studies conducted in the context of oral assessment and university settings, ten grammatical features were selected to investigate grammatical complexity in the responses of the OEPT test takers. Our study explores which grammatical features are more frequently used by the test takers who passed and failed the test. The results show that the OEPT tasks elicited grammatical features commonly found in academic university registers (e.g., classroom teaching). Highly proficient test takers also used grammatical features commonly found in written texts and more extended spoken discourse (e.g., relative clauses) more frequently than lower proficiency ones. We hope that the findings of this study will inform the ongoing rating scale validation for ITA contexts by providing test developers and raters with specific evidence of grammatical features used by test takers at particular scores.