Measuring physical and mental health during pregnancy and postpartum in an Australian childbearing population - validation of the PROMIS Global Short Form.

BACKGROUND: Health related quality of life is a critical concept during the perinatal period but remains under-researched. The International Consortium for Health Outcomes Measurement have included the Patient Reported Outcomes Measurement Information System (PROMIS®) Global Short Form (GSF) in their core outcome set for pregnancy and childbirth to measure health related quality of life. The PROMIS GSF has not been fully evaluated as a valid and reliable instrument in this population. This study assessed the psychometric properties of the PROMIS GSF during pregnancy and postpartum period. METHODS: PROMIS GSF was administered to a sample of 309 pregnant women at four time-points during pregnancy (≤ 27 and 36-weeks) and postpartum (6- and 26-weeks). The structural validity, internal consistency reliability, construct validity, and responsiveness of the PROMIS GSF were evaluated. The internal structure of the PROMIS GSF was explored using Rasch Measurement Theory. Response format, item fit, differential item functioning (item bias), dimensionality of the scale and its targeting were assessed. RESULTS: Two revised subscales (Mental Health: four items; and Physical Health: five items) showed good fit to the Rasch model. The revised mental health subscale demonstrated good internal consistency reliability during pregnancy and postpartum period (α = .88 and .87, respectively). The internal consistency reliability of the physical health subscale was adequate (α = .76 and .75, respectively). The revised mental health subscale was sensitive to group differences according to a history of mental health disorder, income, smoking status, drug use, stress levels and planned versus unplanned pregnancy. Differences in scores on the revised physical subscale were detected for groups based on obesity, income, drug use, smoking status, stress, and history of mental health disorders. Scores on both subscales recorded significant changes across the four time-points, spanning pregnancy and postpartum period. CONCLUSIONS: The revised version of the PROMIS GSF was better able to measure mental and physical health during pregnancy and postpartum period compared to the original version. Findings support the clinical and research application of the PROMIS GSF within the International Consortium for Health Outcomes Measurement Standard Set of Outcome Measures for Pregnancy and Childbirth. Ongoing psychometric analysis of the PROMIS GSF is recommended in other maternity populations.

Criterion Validity of the Child's Challenging Behavior Scale, Version 2 (CCBS-2).

OBJECTIVE: The Child's Challenging Behavior Scale, Version 2 (CCBS-2), measures maternal rating of a child's challenging behaviors that compromise maternal mental health. The CCBS-2, the Child Behavior Checklist (CBCL), and the Strengths and Difficulties Questionnaire (SDQ) were compared in a sample of typically developing young Australian children. METHOD: Criterion validity was investigated by correlating the CCBS-2 with "gold standard" measures (CBCL and SDQ subscales). Data were collected in a cross-sectional survey of mothers (N = 336) of children ages 3-9 yr. RESULTS: Correlations with the CBCL externalizing subscales demonstrated moderate (ρ = .46) to strong (ρ = .66) correlations. Correlations with the SDQ externalizing behaviors subscales were moderate (ρ = .35) to strong (ρ = .60). CONCLUSION: The criterion validity established in this study strengthens the psychometric properties that support ongoing development of the CCBS-2 as an efficient tool that may identify children in need of further evaluation.

Prevalence of burnout, depression, anxiety and stress in Australian midwives: a cross-sectional survey.

BACKGROUND: The health and wellbeing of midwives are important considerations for workforce retention and quality care. The occurrence and relationships among mental health conditions such as burnout and depression have received little attention. We investigated the prevalence of burnout, depression, anxiety and stress in Australian midwives. METHODS: An online survey was conducted in September 2014. Participants were recruited through the Australian College of Midwives and professional networks. The survey sought personal and professional details. Standard measures included the Copenhagen Burnout Inventory (CBI) (Personal, Work and Client subscales), and Depression, Anxiety, and Stress Scale (DASS). The sample was collapsed into two groups according to DASS clinical cut-offs (normal/mild versus moderate/severe/extreme). Effect size statistics were calculated and judged according to Cohen's guidelines. RESULTS: One thousand thirty-seven surveys were received. Respondents were predominantly female (98%), with an average age of 46.43 years, and 16.51 years of practice. Using a CBI subscale cut-off score of 50 and above (moderate and higher), 64.9% (n = 643) reported personal burnout; 43.8% (n = 428) reported work-related burnout; and 10.4% (n = 102) reported client-related burnout. All burnout subscales were significantly correlated with depression, anxiety and stress, particularly personal and work-related burnout with Spearman's rho correlations ranging from .51 to .63 (p < .001). Around 20% of midwives reported moderate/ severe/ extreme levels of depression (17.3%); anxiety (20.4%), and stress (22.1%) symptoms. Mann-Whitney U tests revealed significant differences between groups with depression (r = .43), anxiety (r = .41) and stress (r = 48) having a medium size effect on burnout. CONCLUSION: Prevalence of personal and work-related burnout in Australian midwives was high. The physical and psychological exhaustion associated with the different types of burnout were reflected in symptoms of depression, anxiety and stress symptoms. Further research is needed to support the personal well-being of midwives and minimize workplace burnout by developing short and long term strategies.

Child's Challenging Behaviour Scale, Version 2 (CCBS-2): Psychometric Evaluation With Young Children.

OBJECTIVE: In this article, we evaluate psychometric properties of the Child's Challenging Behaviour Scale, Version 2 (CCBS-2) with mothers of young, typically developing children. METHOD: A cross-sectional mail survey with Australian mothers (N = 337) included the CCBS-2, the Depression Anxiety Stress Scales, and the Parents' Evaluation of Developmental Status scale. RESULTS: Internal consistency was good, and no gender differences in CCBS-2 scores were significant. Significant results included differences between CCBS-2 scores: among children grouped according to age, among children grouped according to pre- and post-school entry, among mothers grouped according to extent of any symptom type, and between this sample and a previously collected age-matched sample of children with disabilities. CONCLUSION: Of the properties tested, results support sound psychometrics. The CCBS-2 can be used to differentiate children according to age, school entry, and disability as well as to identify families for potential services in behavior management and mental health.

Refinement and revalidation of the demoralization scale: The DS-II-internal validity.

BACKGROUND: The Demoralization Scale (DS) was initially validated in 2004 to enable the measurement of demoralization in patients with advanced cancer. Subsequent shortcomings indicated the need for psychometric strengthening. Here, the authors report on the refinement and revalidation of the DS to form the DS-II, specifically reporting the scale's internal validity. METHODS: Patients with cancer or other progressive diseases who were receiving palliative care (n = 211) completed a revised version of the 24-item DS and a measure of symptom burden (the Memorial Symptom Assessment Scale). Exploratory factor analysis and Rasch modeling were used to evaluate, modify, and revalidate the scale, providing information about dimensionality, suitability of response format, item fit, item bias, and item difficulty. Test-retest reliability was examined for 58 symptomatically stable patients at a 5-day follow-up. RESULTS: Exploratory factor analysis supported a 22-item, 2-component model. Separate Rasch modeling of each component resulted in collapsing the response option categories and removing 3 items from each component. Both final 8-item subscales met Rasch model expectations and were appropriate to sum as a 16-item total score. The DS-II demonstrated internal consistency and test-retest reliability (Meaning and Purpose subscale: α = .84; intraclass correlation [ICC] = 0.68; Distress and Coping Ability subscale: α = .82; ICC = 0.82; total DS: α = .89; ICC = 0.80). CONCLUSIONS: The DS-II is a 3-point response, self-report scale comprising 16 items and 2 subscales. Given its revalidation, psychometric strengthening, and simplification, the DS-II is an improved and more practical measure of demoralization for research and clinical use. External validation of the DS-II will be reported subsequently. Cancer 2016;122:2251-9. © 2016 American Cancer Society.

Rasch analysis of the Personal Wellbeing Index.

PURPOSE: The Personal Wellbeing Index (PWI) is used internationally to measure subjective well-being. While numerous studies have reported on the psychometric properties of the PWI using classic test theory, the current paper provides additional psychometric evaluation using the Rasch measurement model. METHOD: The responses to the PWI items of 593 healthy adults living in Australia or Canada were analysed using Rasch analysis. Assessed were overall model fit was assessed, individual person fit and item fit, reliability, differential item functioning (DIF), unidimensionality, targeting, and response format. RESULTS: Results indicate excellent psychometric properties of the PWI, provided the religion/spirituality item is excluded. The seven-item PWI showed good model fit (overall item-trait interaction χ (2) = 70.59, df = 63, p = 0.24), excellent person separation (PSI = .89), no item or person misfit, and no DIF for country or gender, and unidimensionality was supported. In addition, only very mild disordered thresholds were observed for the 'safety' item, indicating that overall, the 11-point response format was suitable for this population. CONCLUSION: It is recommended that the religion/spirituality item not be included in the aggregated or averaged total score in Western context and that caution should be used in comparison across different groups where the eight-item version has been used.

Evaluation of Internal Construct Validity and Unidimensionality of the Brachial Assessment Tool, A Patient-Reported Outcome Measure for Brachial Plexus Injury.

OBJECTIVE: To evaluate the internal construct validity and dimensionality of a new patient-reported outcome measure for people with traumatic brachial plexus injury (BPI) based on the International Classification of Functioning, Disability and Health definition of activity. DESIGN: Cross-sectional study. SETTING: Outpatient clinics. PARTICIPANTS: Adults (age range, 18-82y) with a traumatic BPI (N=106). INTERVENTIONS: There were 106 people with BPI who completed a 51-item 5-response questionnaire. Responses were analyzed in 4 phases (missing responses, item correlations, exploratory factor analysis, and Rasch analysis) to evaluate the properties of fit to the Rasch model, threshold response, local dependency, dimensionality, differential item functioning, and targeting. MAIN OUTCOME MEASURES: Not applicable, as this study addresses the development of an outcome measure. RESULTS: Six items were deleted for missing responses, and 10 were deleted for high interitem correlations >.81. The remaining 35 items, while demonstrating fit to the Rasch model, showed evidence of local dependency and multidimensionality. Items were divided into 3 subscales: dressing and grooming (8 items), arm and hand (17 items), and no hand (6 items). All 3 subscales demonstrated fit to the model with no local dependency, minimal disordered thresholds, no unidimensionality or differential item functioning for age, time postinjury, or self-selected dominance. Subscales were combined into 3 subtests and demonstrated fit to the model, no misfit, and unidimensionality, allowing calculation of a summary score. CONCLUSIONS: This preliminary analysis supports the internal construct validity of the Brachial Assessment Tool, a unidimensional targeted 4-response patient-reported outcome measure designed to solely assess activity after traumatic BPI regardless of level of injury, age at recruitment, premorbid limb dominance, and time postinjury. Further examination is required to determine test-retest reliability and responsiveness.

Making Sense of Variations in Prevalence Estimates of Depression in Cancer: A Co-Calibration of Commonly Used Depression Scales Using Rasch Analysis.

BACKGROUND: The use of different depression self-report scales warrants co-calibration studies to establish relationships between scores from 2 or more scales. The goal of this study was to examine variations in measurement across 5 commonly used scales to measure depression among patients with cancer: Hospital Anxiety and Depression Scale-Depression subscale (HADS-D), Centre for Epidemiologic Studies Depression Scale (CES-D), Patient Health Questionnaire-9 (PHQ-9), Beck Depression Inventory-II (BDI-II), and Depression Anxiety and Stress Scale-Depression subscale (DASS-D). METHODS: The depression scales were completed by 162 patients with cancer. Participants were also assessed by the major depressive episode module of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Rasch analysis and receiver operating characteristic curves were performed. RESULTS: Rasch analysis of the 5 scales indicated that these all measured depression. The HADS and BDI-II had the widest measurement range, whereas the DASS-D had the narrowest range. Co-calibration revealed that the cutoff scores across the scales were not equivalent. The mild cutoff score on the PHQ-9 was easier to meet than the mild cutoff score on the CES-D, BDI-II, and DASS-D. The HADS-D possible cutoff score was equivalent to cutoff scores for major to severe depression on the other scales. Optimal cutoff scores for clinical assessment of depression were in the mild to moderate depression range for most scales. CONCLUSIONS: The labels of depression associated with the different scales are not equivalent. Most markedly, the HADS-D possible case cutoff score represents a much higher level of depression than equivalent scores on other scales. Therefore, use of different scales will lead to different estimates of prevalence of depression when used in the same sample.

Investigation of the self-reported health and health-related behaviours of Victorian mothers of school-aged children.

Lifestyle may influence many health-related issues currently facing Australian women. The extent to which women with school-aged children attend to their own health is unknown and the associations between health behaviours and health status requires investigation. This study aimed to investigate the prevalence of health behaviours (alcohol consumption, health-promoting activities) and their impact on self-reported health (weight, sleep quality, mental health) among mothers of school-aged children in Victoria. Mail-out survey design (n=263) including the Depression Anxiety Stress Scale (DASS) and Health Promoting Activities Scale was used to explore issues. The results indicated that substantial numbers of mothers reported moderate to extreme DASS scores: depression (n=45, 17%); anxiety (n=41, 15.6%); stress (n=57, 21.7%). The majority participated in physical activity less often than daily. High rates of daily alcohol use (20%) and poor sleep quality were reported. Nearly one-half (n=114, 46%) of the sample were overweight or obese and also reported poorer mental health than other women in the sample (P<0.001). Significant associations were detected between maternal weight, mental health and participation in health-promoting activities. The findings indicate that there is a need for increased health education and services for women with school-aged children. Direct services and population-based health promotion strategies may be required to address healthy lifestyle issues and educate mothers about the possible health legacy of poor health behaviours.

Rasch analysis of The Melbourne Assessment of Unilateral Upper Limb Function.

AIM: This study investigated the internal construct validity and dimensionality of the Melbourne Assessment of Unilateral Upper Limb Function (Melbourne Assessment), a widely-used measure of quality of upper limb movement, valid for children aged 2 years 6 months to 15 years with cerebral palsy. METHOD: Rasch analysis was used to assess of Melbourne Assessment raw scores for 163 children (94 males, 69 females; mean age 8y, SD 3y 5mo). Analysis was undertaken on the full scale comprising 37 scores and on groups of scores separated into four distinct movement subscales: range of movement, accuracy, dexterity, and fluency. Tests were conducted to evaluate overall model fit, item fit, suitability of the response options, unidimensionality, and differential item functioning (DIF) for sex, child age, and different raters. RESULTS: The results did not support the unidimensionality of the 37-score scale. The four subscales showed adequate model fit after removal of some score items, and rescaling of others. The resulting subscales showed good internal consistency and no DIF for sex or child age. INTERPRETATION: This study provides empirical support for a revised version of the Melbourne Assessment which comprises 14 tasks and 30 movement scores grouped across four separate subscales. Further testing is required to assess the responsiveness of subscales to clinically important change.

Using Rasch analysis to examine the distress thermometer's cut-off scores among a mixed group of patients with cancer.

PURPOSE: The distress thermometer (DT) is commonly used in cancer care to improve detection of distress. The DT's recommended cut-off score of 4 or 5 has typically been established using the Hospital Anxiety and Depression Scale (HADS) by receiver operating characteristic curve analysis. The present analysis complements these studies by critically examining the use of the HADS to identify the DT's cut-off score and corroborating the DT's cut-off scores using item response theory (Rasch analysis). METHODS: The DT and HADS were completed by 340 patients with cancer. Rasch dimensionality analysis was performed on the HADS-Total, and test characteristic curves were examined to equate the DT and the HADS subscales. Identified DT cut-off scores were then examined for their sensitivity and specificity. RESULTS: Rasch analysis did not support the unidimensionality of HADS-Total. The test characteristic curves indicated that a cut-off score of ≥8 on the HADS-Anxiety and HADS-Depression subscales was equivalent to a score of 6 and 7 on the DT, respectively. However, a DT cut-off score of 5 resulted in the best balance between sensitivity and specificity across the HADS-Anxiety and HADS-Depression subscales. CONCLUSIONS: Despite being a popular practice, the present findings did not support combining the HADS-Anxiety and HADS-Depression subscales to identify the DT's cut-off score. Furthermore, these results inform the use of the DT as a preliminary screening tool and suggest that when a single screen is used, a DT cut-off score of 6 or 7 might be more appropriate than the typical cut-off score of 4.

Assessment of the internal construct validity of the revised High-Level Mobility Assessment Tool for traumatic orthopaedic injuries.

OBJECTIVE: To determine whether the revised High-Level Mobility Assessment Tool (HiMAT) was valid for measuring mobility for people with multi-trauma orthopaedic lower limb injuries. DESIGN: Cross-sectional study. SUBJECTS: Participants with lower limb multi-trauma orthopaedic injuries. METHODS: One complete revised HiMAT was obtained for 106 people within 12 weeks of being allowed to fully weight bear. Rasch analysis was used to assess the overall fit of the model for individuals and items, differential item functioning, local dependency, targeting of items and dimensionality. RESULTS: The mean revised HiMAT score was 10.5 (SD = 6.8) with a range of 5-30. Rasch analysis of revised HiMAT showed adequate overall fit to the model (P = 0.29) with no misfitting items (fit residual SD = 0.69) or persons (fit residual SD = 0.62). The scale showed good internal consistency (Person Separation Index = 0.91). One item (hopping) demonstrated disordered thresholds, however this item had good fit to the model in all other aspects. The revised HiMAT was unidimensional, and no differential item functioning was detected for gender or age. The revised HiMAT was well targeted for this group with a range of items across all ability levels. CONCLUSION: The results of this study support the internal construct validity of the revised HiMAT as a well-targeted, unidimensional measure of high-level mobility with no ceiling or floor effect for males and females recovering from multi-trauma orthopaedic lower limb injuries.

Evaluation of the internal construct validity of the Personal Care Participation Assessment and Resource Tool (PC-PART) using Rasch analysis.

BACKGROUND: The Personal Care Participation Assessment and Resource Tool (PC-PART) is a 43-item, clinician-administered assessment, designed to identify patients' unmet needs (participation restrictions) in activities of daily living (ADL) required for community life. This information is important for identifying problems that need addressing to enable, for example, discharge from inpatient settings to community living. The objective of this study was to evaluate internal construct validity of the PC-PART using Rasch methods. METHODS: Fit to the Rasch model was evaluated for 41 PC-PART items, assessing threshold ordering, overall model fit, individual item fit, person fit, internal consistency, Differential Item Functioning (DIF), targeting of items and dimensionality. Data used in this research were taken from admission data from a randomised controlled trial conducted at two publically funded inpatient rehabilitation units in Melbourne, Australia, with 996 participants (63% women; mean age 74 years) and with various impairment types. RESULTS: PC-PART items assessed as one scale, and original PC-PART domains evaluated as separate scales, demonstrated poor fit to the Rasch model. Adequate fit to the Rasch model was achieved in two newly formed PC-PART scales: Self-Care (16 items) and Domestic Life (14 items). Both scales were unidimensional, had acceptable internal consistency (PSI =0.85, 0.76, respectively) and well-targeted items. CONCLUSIONS: Rasch analysis did not support conventional summation of all PC-PART item scores to create a total score. However, internal construct validity of the newly formed PC-PART scales, Self-Care and Domestic Life, was supported. Their Rasch-derived scores provided interval-level measurement enabling summation of scores to form a total score on each scale. These scales may assist clinicians, managers and researchers in rehabilitation settings to assess and measure changes in ADL participation restrictions relevant to community living. TRIAL REGISTRATION: Data used in this research were gathered during a registered randomised controlled trial: Australian and New Zealand Clinical Trials Registry ACTRN12609000973213. Ethics committee approval was gained for secondary analysis of data for this study.

Measuring vocal function in professional music theater singers: construct validation of the Evaluation of the Ability to Sing Easily (EASE).

OVERVIEW: Working music theater singers (MTS) typically have a heavy vocal load and little is known about their perception of vocal function. The Evaluation of the Ability to Sing Easily (EASE) was used to assess professional MTS' perceptions of current singing voice status and to compare scores across demographic and performance characteristics and to evaluate the construct validity of the EASE and its subscales (VF = Vocal Fatigue, PRI = Pathologic-Risk Indicators). METHODS: Professional MTS (n = 284) completed an online survey including the EASE and two additional Vocal Concern (VC) items. Scores were compared across age, gender, whether currently working, role, perceived vocal load over the past 24 h and self-reported voice problem. RESULTS: For the whole cohort, statistically significant differences were found on all subscales according to whether or not singers perceived themselves to have a voice problem (p < 0.001). Currently performing singers were significantly different from those not performing in a show on the EASE Total (p = 0.014) and VF (p = 0.002), but not for PRI and VC. In the currently performing singer group, significant differences were found for gender, role and perceived voice problem on the EASE Total and all subscales (p < 0.01). Significantly higher VF scores were recorded for singers with heavy vocal load (p = 0.01), but there were no differences on the EASE Total (p = 0.57), PRI (p = 0.19) or VC subscales (p = 0.53). Among these performing singers, no significant age differences were found for any EASE subscales. CONCLUSIONS: These findings provide further validation of the EASE as a useful tool for measuring singers' perceptions of vocal function and suggest that the subscales should be scored separately. Future evaluation of the EASE against objective clinical assessments (e.g., videostroboscopy) is recommended.

Further validation of the Health Promoting Activities Scale with mothers of typically developing children.

BACKGROUND/AIM: The Health Promoting Activities Scale (HPAS) measures the frequency that mothers participate in self-selected leisure activities that promote health and wellbeing. The scale was originally validated on mothers of school-aged children with disabilities, and the current article extends this research using a comparative sample of mothers of typically developing school-aged children. METHOD: Australian mothers (N = 263) completed a questionnaire containing the HPAS, a measure of depression, anxiety and stress (DASS-21) and questions concerning their weight, height, sleep quality and demographics. Statistical analysis assessed the underlying structure, internal consistency and construct validity of the HPAS. Inferential statistics were utilised to investigate the construct validity. RESULTS: Exploratory factor analysis supported the unidimensionality of the HPAS. It showed good internal consistency (Cronbach's alpha = 0.78). Significantly lower HPAS scores were recorded for women who were obese; had elevated levels of depression, anxiety and stress; had poor quality sleep or had heavy caring commitments. The mean HPAS score in this sample (M = 32.2) was significantly higher than was previously reported for women of children with a disability (M = 21.6: P < 0.001). CONCLUSIONS: Further psychometric evaluation of the HPAS continues to support the HPAS as a sound instrument that measures the frequency that women participate in meaningful occupation that is associated with differences in mental health and wellbeing and other health indicators.

Validation of the Charcot-Marie-Tooth disease pediatric scale as an outcome measure of disability.

OBJECTIVE: Charcot-Marie-Tooth disease (CMT) is a common heritable peripheral neuropathy. There is no treatment for any form of CMT, although clinical trials are increasingly occurring. Patients usually develop symptoms during the first 2 decades of life, but there are no established outcome measures of disease severity or response to treatment. We identified a set of items that represent a range of impairment levels and conducted a series of validation studies to build a patient-centered multi-item rating scale of disability for children with CMT. METHODS: As part of the Inherited Neuropathies Consortium, patients aged 3 to 20 years with a variety of CMT types were recruited from the USA, United Kingdom, Italy, and Australia. Initial development stages involved definition of the construct, item pool generation, peer review, and pilot testing. Based on data from 172 patients, a series of validation studies were conducted, including item and factor analysis, reliability testing, Rasch modeling, and sensitivity analysis. RESULTS: Seven areas for measurement were identified (strength, dexterity, sensation, gait, balance, power, endurance), and a psychometrically robust 11-item scale was constructed (CMT Pediatric Scale [CMTPedS]). Rasch analysis supported the viability of the CMTPedS as a unidimensional measure of disability in children with CMT. It showed good overall model fit, no evidence of misfitting items, and no person misfit, and it was well targeted for children with CMT. INTERPRETATION: The CMTPedS is a well-tolerated outcome measure that can be completed in 25 minutes. It is a reliable, valid, and sensitive global measure of disability for children with CMT from the age of 3 years.

Relationships between sleep disruptions, health and care responsibilities among mothers of school-aged children with disabilities.

AIM: Sleep problems are more common among children with disabilities. Mothers are likely to provide night-time care. Mothers of children with disabilities are known to experience high levels of stress and mental health issues compared with other mothers. Relationships between a child's sleep problems, and chronic maternal sleep interruption and subjective health have not been researched. METHOD: Cross-sectional mail-out survey with follow-up phone call was used. Instruments included the Short Form 36 version 2 and instruments that measured maternal, child and sleep characteristics. Descriptive statistics examined characteristics of participants and correlation, and Kruskal-Wallis test was used to determine important maternal and child characteristics around sleep issues. RESULTS: All mothers (n = 152) cared for a school-aged child with a developmental disability including autism spectrum disorder (n = 94) and cerebral palsy (n = 29). Nearly half (49%) of the mothers were awoken more than 4 nights/week. Three distinct sleep groups were identified: no sleep interruption; sleep interruption once/night, 4 nights/week; and more frequent interruption. Mothers experiencing the most sleep interruptions reported significantly poorer health on six Short Form 36 version 2 dimensions. Night-time caregiving was associated with higher child care needs rather than children's diagnoses. Mothers who experienced more sleep interruption also participated less in health-promoting activities (active leisure, time with socially supportive others) during the day. CONCLUSION: This study identifies a group of mothers with chronic sleep interruption and demonstrates related poor maternal subjective health and lower participation in health activities that may service to support maternal health. Mothers with children with the highest daytime care needs also experienced high night-time care responsibilities. Changes to service provision are recommended to identify mothers in need of additional supports and services.

Rasch analysis of the Mini-Mental Adjustment to Cancer Scale (mini-MAC) among a heterogeneous sample of long-term cancer survivors: a cross-sectional study.

BACKGROUND: The mini-Mental Adjustment to Cancer Scale (mini-MAC) is a well-recognised, popular measure of coping in psycho-oncology and assesses five cancer-specific coping strategies. It has been suggested that these five subscales could be grouped to form the over-arching adaptive and maladptive coping subscales to facilitate the interpretation and clinical application of the scale. Despite the popularity of the mini-MAC, few studies have examined its psychometric properties among long-term cancer survivors, and further validation of the mini-MAC is needed to substantiate its use with the growing population of survivors. Therefore, this study examined the psychometric properties and dimensionality of the mini-MAC in a sample of long-term cancer survivors using Rasch analysis. METHODS: RUMM 2030 was used to analyse the mini-MAC data (n=851). Separate Rasch analyses were conducted for each of the original mini-MAC subscales as well as the over-arching adaptive and maladaptive coping subscales to examine summary and individual model fit statistics, person separation index (PSI), response format, local dependency, targeting, item bias (or differential item functioning -DIF), and dimensionality. RESULTS: For the fighting spirit, fatalism, and helplessness-hopelessness subscales, a revised three-point response format seemed more optimal than the original four-point response. To achieve model fit, items were deleted from four of the five subscales - Anxious Preoccupation items 7, 25, and 29; Cognitive Avoidance items 11 and 17; Fighting Spirit item 18; and Helplessness-Hopelessness items 16 and 20. For those subscales with sufficient items, analyses supported unidimensionality. Combining items to form the adaptive and maladaptive subscales was partially supported. CONCLUSIONS: The original five subscales required item deletion and/or rescaling to improve goodness of fit to the Rasch model. While evidence was found for overarching subscales of adaptive and maladaptive coping, extensive modifications were necessary to achieve this result. Further exploration and validation of over-arching subscales assessing adaptive and maladaptive coping is necessary with cancer survivors.

Validation of the Neurological Fatigue Index for stroke (NFI-Stroke).

BACKGROUND: Fatigue is a common symptom in Stroke. Several self-report scales are available to measure this debilitating symptom but concern has been expressed about their construct validity. OBJECTIVE: To examine the reliability and validity of a recently developed scale for multiple sclerosis (MS) fatigue, the Neurological Fatigue Index (NFI-MS), in a sample of stroke patients. METHOD: Six patients with stroke participated in qualitative interviews which were analysed and the themes compared for equivalence to those derived from existing data on MS fatigue. 999 questionnaire packs were sent to those with a stroke within the past four years. Data from the four subscales, and the Summary scale of the NFI-MS were fitted to the Rasch measurement model. RESULTS: Themes identified by stroke patients were consistent with those identified by those with MS. 282 questionnaires were returned and respondents had a mean age of 67.3 years; 62% were male, and were on average 17.2 (SD 11.4, range 2-50) months post stroke. The Physical, Cognitive and Summary scales all showed good fit to the model, were unidimensional, and free of differential item functioning by age, sex and time. The sleep scales failed to show adequate fit in their current format. CONCLUSION: Post stroke fatigue appears to be represented by a combination of physical and cognitive components, confirmed by both qualitative and quantitative processes. The NFI-Stroke, comprising a Physical and Cognitive subscale, and a 10-item Summary scale, meets the strictest measurement requirements. Fit to the Rasch model allows conversion of ordinal raw scores to a linear metric.

Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS).

BACKGROUND: While it is recognised that depression is prevalent in Rheumatoid Arthritis (RA), recent studies have also highlighted significant levels of anxiety in RA patients. This study compared two commonly used scales, the Depression Anxiety and Stress Scale (DASS) and the Hospital Anxiety and Depression Scale (HADS), in relation to their measurement range and cut points to consider the relative prevalence of both constructs, and if prevalence rates may be due to scale-specific case definition. METHODS: Patients meeting the criteria for RA were recruited in Leeds, UK and Sydney, Australia and asked to complete a survey that included both scales. The data was analysed using the Rasch measurement model. RESULTS: A total of 169 RA patients were assessed, with a repeat subsample, resulting in 323 cases for analysis. Both scales met Rasch model expectations. Using the 'possible+probable' cut point from the HADS, 58.3% had neither anxiety nor depression; 13.5% had anxiety only; 6.4% depression only and 21.8% had both 'possible+probable' anxiety and depression. Cut points for depression were comparable across the two scales while a lower cut point for anxiety in the DASS was required to equate prevalence. CONCLUSIONS: This study provides further support for high prevalence of depression and anxiety in RA. It also shows that while these two scales provide a good indication of possible depression and anxiety, the estimates of prevalence so derived could vary, particularly for anxiety. These findings are discussed in terms of comparisons across studies and selection of scales for clinical use.