Development and Initial Validation of the PROMIS(®) Sexual Function and Satisfaction Measures Version 2.0.

INTRODUCTION: The Patient-Reported Outcomes Measurement Information System (PROMIS)(®) Sexual Function and Satisfaction measure (SexFS) version 1.0 was developed with cancer populations. There is a need to expand the SexFS and provide evidence of its validity in diverse populations. AIM: The aim of this study was to describe the development of the SexFS v2.0 and present preliminary evidence for its validity. METHODS: Development built on version 1.0, plus additional review of extant items, discussions with 15 clinical experts, 11 patient focus groups (including individuals with diabetes, heart disease, anxiety, depression, and/or are lesbian, gay, bisexual, or aged 65 or older), 48 cognitive interviews, and psychometric evaluation in a random sample of U.S. adults plus an oversample for specific sexual problems (2281 men, 1686 women). We examined differential item functioning (DIF) by gender and sexual activity. We examined convergent and known-groups validity. RESULTS: The final set of domains includes 11 scored scales (interest in sexual activity, lubrication, vaginal discomfort, clitoral discomfort, labial discomfort, erectile function, orgasm ability, orgasm pleasure, oral dryness, oral discomfort, satisfaction), and six nonscored item pools (screeners, sexual activities, anal discomfort, therapeutic aids, factors interfering with sexual satisfaction, bother). Domains from version 1.0 were reevaluated and improved. Domains considered applicable across gender and sexual activity status, namely interest, orgasm, and satisfaction, were found to have significant DIF. We identified subsets of items in each domain that provided consistent measurement across these important respondent groups. Convergent and known-groups validity was supported. CONCLUSIONS: The SexFS version 2.0 has several improvements and enhancements over version 1.0 and other extant measures, including expanded evidence for validity, scores centered around norms for sexually active U.S. adults, new domains, and a final set of items applicable for both men and women and those sexually active with a partner and without. The SexFS is customizable, allowing users to select relevant domains and items for their study.

Maintaining Content Validity in Computerized Adaptive Testing.

A major advantage of using computerized adaptive testing (CAT) is improved measurement efficiency; better score reliability or mastery decisions can result from targeting item selections to the abilities of examinees. However, this type of engineering solution can result in differential content for different examinees at various levels of ability. This paper empirically demonstrates some of the trade-offs which can occur when content balancing is imposed in CAT forms or conversely, when it is ignored. That is, the content validity of a CAT form can actually change across a score scale when content balancing is ignored. On the other hand, efficiency and score precision can be severely reduced by over specifying content restrictions in a CAT form. The results from two simulation studies are presented as a means of highlighting some of the trade-offs that could occur between content and statistical considerations in CAT form assembly.

A preliminary multifactorial approach describing the relationships among lower extremity alignment, hip muscle activation, and lower extremity joint excursion.

CONTEXT: Multiple factors have been suggested to increase the risk of faulty dynamic alignments that predict noncontact anterior cruciate ligament injury. Few researchers have examined this relationship using an integrated, multifactorial approach. OBJECTIVE: To describe the relationship among static lower extremity alignment (LEA), hip muscle activation, and hip and knee motion during a single-leg squat. DESIGN: Descriptive laboratory study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: Thirty men (age= 23.9± 3.6 years, height =178.5± 9.9 cm, mass= 82.0± 14.1 kg) and 30 women (age= 22.2± 2.6 years, height= 162.4± 6.3 cm, mass= 60.3± 8.1 kg). MAIN OUTCOME MEASURE(S): Pelvic angle, femoral anteversion, quadriceps angle, tibiofemoral angle, and genu recurvatum were measured to the nearest degree; navicular drop was measured to the nearest millimeter. The average root mean square amplitude of the gluteus medius and maximus muscles was assessed during the single-leg squat and normalized to the peak root mean square value during maximal contractions for each muscle. Kinematic data of hip and knee were also assessed during the single-leg squat. Structural equation modeling was used to describe the relationships among static LEA, hip muscle activation, and joint kinematics, while also accounting for an individual's sex and hip strength. RESULTS: Smaller pelvic angle and greater femoral anteversion, tibiofemoral angle, and navicular drop predicted greater hip internal-rotation excursion and knee external-rotation excursion. Decreased gluteus maximus activation predicted greater hip internal-rotation excursion but decreased knee valgus excursion. No LEA characteristic predicted gluteus medius or gluteus maximus muscle activation during the single-leg squat. CONCLUSIONS: Static LEA, characterized by a more internally rotated hip and valgus knee alignment and less gluteus maximus activation, was related to commonly observed components of functional valgus collapse during the single-leg squat. This exploratory analysis suggests that LEA does not influence hip muscle activation in controlling joint motion during a single-leg squat.