Validity and reliability of the Cochlear Implant Quality of Life (CIQOL)-35 Profile and CIQOL-10 Global instruments in comparison to legacy instruments.

OBJECTIVE: Validated and reliable patient-reported outcome measures (PROMs) may provide a comprehensive and accurate assessment of the real-world experiences of cochlear implant (CI) users and complement information obtained from speech recognition outcomes. To address this unmet clinical need, the Cochlear Implant Quality of Life (CIQOL)-35 Profile instrument and CIQOL-10 Global measure were developed according to the Patient-Reported Outcomes Information System (PROMIS) and COnsensus-based Standards for the Selection of health status Measurement INstruments (COSMIN) guidelines. The CIQOL-35 Profile consists of 35 items in six domain constructs (communication, emotional, entertainment, environment, listening effort, and social) and the CIQOL-10 Global contains 10 items that provide an overall CIQOL score. The present study compares psychometric properties of the newly developed CIQOL instruments to two legacy PROMs commonly used in adult CI users. DESIGN: Using a prospective cohort design, a sample of 334 adult CI users recruited from across the United States provided responses to (1) the CIQOL instruments; (2) a CI-specific PROM (Nijmegen Cochlear Implant Questionnaire, NCIQ); and (3) a general-health PROM (Health Utilities Index 3 [HUI-3]). Responses were obtained again after 1 mo. The reliability and validity of the CIQOL-35 Profile and CIQOL-10 Global instruments were compared with the legacy PROMs (NCIQ and HUI-3). Psychometric properties and construct validity of each instrument were analyzed using confirmatory factor analysis, item response theory (IRT), and test-retest reliability (using Pearson's correlations), where appropriate. RESULTS: All six CIQOL-35 Profile domains and the CIQOL-10 Global instrument demonstrated adequate to strong construct validity. The majority of the NCIQ subdomains and NCIQ total score had substantial confirmatory factor analysis model misfit, representing poor construct validity. Therefore, IRT analysis could only be applied to the basic sound performance and activity limitation subdomains of the NCIQ. IRT results showed strong psychometric properties for all CIQOL-35 Profile domains, the CIQOL-10 Global instrument, and the basic sound performance and activity limitation subdomains of the NCIQ. Test-retest reliability was strong for the CIQOL-35 Profile, CIQOL-10 Global, and NCIQ, but moderate to weak for the HUI-3; the hearing score of the HUI-3 demonstrated the weakest reliability. CONCLUSION: The CIQOL-35 Profile and CIQOL-10 Global are more psychometrically sound and comprehensive than the NCIQ and the HUI-3 for assessing QOL in adult CI users. Due to poor reliability, we do not recommend using the HUI-3 to measure QOL in this population. With validation and psychometric analyses complete, the CIQOL-35 Profile measure and CIQOL-10 Global instrument are now ready for use in clinical and research settings to measure QOL and real-world functional abilities of adult CI users.

Using Measurement to Highlight Occupational Therapy's Distinct Value.

Traditional measurement approaches in health care focus on group data, virtually ignoring the individual client. To demonstrate the distinct value of occupational therapy, we need a measurement model that focuses on the person and generates outputs to inform daily practice. Traditional methods of establishing norms and predictive validity do not inform the development of interventions and goal setting. In this Eleanor Clarke Slagle Lecture, I use a person-centered measurement model that focuses on the person, versus the instrument, to demonstrate how person-centered measurement can be immediately used to identify the just-right challenge for the client. Person-centered measurement can be both the basis for designing interventions specific to the client and the foundation for setting empirically appropriate short-term and long-term goals. Occupational therapy practitioners can lead health care by immediately applying person-centered measurement to address the needs of individual clients and, moreover, to reveal the distinct value of occupational therapy.

Using Measurement to Highlight Occupational Therapy's Distinct Value.

Traditional measurement approaches in health care focus on group data, virtually ignoring the individual client. To demonstrate the distinct value of occupational therapy, we need a measurement model that focuses on the person and generates outputs to inform daily practice. Traditional methods of establishing norms and predictive validity do not inform the development of interventions and goal setting. In this Eleanor Clarke Slagle Lecture, I use a person-centered measurement model that focuses on the person, versus the instrument, to demonstrate how person-centered measurement can be immediately used to identify the just-right challenge for the client. Person-centered measurement can be both the basis for designing interventions specific to the client and the foundation for setting empirically appropriate short-term and long-term goals. Occupational therapy practitioners can lead health care by immediately applying person-centered measurement to address the needs of individual clients and, moreover, to reveal the distinct value of occupational therapy.

Development of the Cochlear Implant Quality of Life Item Bank.

OBJECTIVES: Functional outcomes following cochlear implantation have traditionally been focused on word and sentence recognition, which, although important, do not capture the varied communication and other experiences of adult cochlear implant (CI) users. Although the inadequacies of speech recognition to quantify CI user benefits are widely acknowledged, rarely have adult CI user outcomes been comprehensively assessed beyond these conventional measures. An important limitation in addressing this knowledge gap is that patient-reported outcome measures have not been developed and validated in adult CI patients using rigorous scientific methods. The purpose of the present study is to build on our previous work and create an item bank that can be used to develop new patient-reported outcome measures that assess CI quality of life (QOL) in the adult CI population. DESIGN: An online questionnaire was made available to 500 adult CI users who represented the adult CI population and were recruited through a consortium of 20 CI centers in the United States. The questionnaire included the 101 question CIQOL item pool and additional questions related to demographics, hearing and CI history, and speech recognition scores. In accordance with the Patient-Reported Outcomes Measurement Information System, responses were psychometrically analyzed using confirmatory factor analysis and item response theory. RESULTS: Of the 500 questionnaires sent, 371 (74.2%) subjects completed the questionnaire. Subjects represented the full range of age, durations of CI use, speech recognition abilities, and listening modalities of the adult CI population; subjects were implanted with each of the three CI manufacturers' devices. The initial item pool consisted of the following domain constructs: communication, emotional, entertainment, environment, independence, listening effort, and social. Through psychometric analysis, after removing locally dependent and misfitting items, all of the domains were found to have sound psychometric properties, with the exception of the independence domain. This resulted in a final CIQOL item bank of 81 items in 6 domains with good psychometric properties. CONCLUSIONS: Our findings reveal that hypothesis-driven quantitative analyses result in a psychometrically sound CIQOL item bank, organized into unique domains comprised of independent items which measure the full ability range of the adult CI population. The final item bank will now be used to develop new instruments that evaluate and differentiate adult CIQOL across the patient ability spectrum.

Multidimensionality of the PROMIS self-efficacy measure for managing chronic conditions.

PURPOSE: This study investigated the PROMIS Self-Efficacy Measure for Managing Chronic Conditions (PROMIS-SE) domain distributions and examined the factor structure of the PROMIS-SE. METHODS: A total of 1087 individuals with chronic conditions participated in this study. PROMIS-SE's item banks and two short forms (eight-item and four-item) measuring five behavioral domains (daily activities(DA), Emotions(EM), medications and treatments(MT), social interactions(SS), and Symptoms(SX)) were examined. PROMIS-SE's T-score ranges and distributions were examined to identify domain metric distributions and confirmatory factor analysis (CFA) was conducted to test a multidimensional model fit to the PROMIS-SE. RESULTS: PROMIS-SE domains showed different T-score ranges and distributions for item banks and two short forms across all five domains. While PROMIS-SE EM demonstrated the highest T-scores (least negatively skewed), MT had the lowest T-scores (most negatively skewed) for all three forms. In general, respondents were more likely to achieve highest self-efficacy ratings (very confident) for domains DA, MT, and SS as compared to domains EM and SX. CFA confirmed that a multidimensional model adequately fit all three PROMIS-SE forms. CONCLUSION: Our results indicate that self-efficacy T-distributions are not consistent across domains (i.e., managing medications and treatments domain was more negatively skewed difficult than other domains), which is a requirement for making inter-domain comparisons. A multidimensional model could be used to enhance the PROMIS-SE's estimate accuracy and clinical utility.

FIM-Minimum Data Set Motor Item Bank: Short Forms Development and Precision Comparison in Veterans.

OBJECTIVE: To improve the practical use of the short forms (SFs) developed from the item bank, we compared the measurement precision of the 4- and 8-item SFs generated from a motor item bank composed of the FIM and the Minimum Data Set (MDS). DESIGN: The FIM-MDS motor item bank allowed scores generated from different instruments to be co-calibrated. The 4- and 8-item SFs were developed based on Rasch analysis procedures. This article compared person strata, ceiling/floor effects, and test SE plots for each administration form and examined 95% confidence interval error bands of anchored person measures with the corresponding SFs. We used 0.3 SE as a criterion to reflect a reliability level of .90. SETTING: Veterans' inpatient rehabilitation facilities and community living centers. PARTICIPANTS: Veterans (N=2500) who had both FIM and the MDS data within 6 days during 2008 through 2010. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Four- and 8-item SFs of FIM, MDS, and FIM-MDS motor item bank. RESULTS: Six SFs were generated with 4 and 8 items across a range of difficulty levels from the FIM-MDS motor item bank. The three 8-item SFs all had higher correlations with the item bank (r=.82-.95), higher person strata, and less test error than the corresponding 4-item SFs (r=.80-.90). The three 4-item SFs did not meet the criteria of SE <0.3 for any theta values. CONCLUSIONS: Eight-item SFs could improve clinical use of the item bank composed of existing instruments across the continuum of care in veterans. We also found that the number of items, not test specificity, determines the precision of the instrument.

Comparing Disability Levels for Community-dwelling Adults in the United States and the Republic of Korea using the Rasch Model.

This study compared disability levels between community-dwelling adults in the United States and South Korea using two national surveys of the United States and Korean National Health and Examination Survey (NHANES and KNHANES). The Rasch common-item equating method was used to create the same measurement framework and compared average disability levels. The disability levels between the two countries were estimated using the current disability estimation method (percentage of people having disability based on a single question). A higher percentage of American adults (20.5%) showed disability than the Korean adults (9.6%) based on the current estimation method; however, using the Rasch model American adults had significantly less disability (Mean = -3.00 logits, SD = 1.67) than the Korean adults (Mean = -2.48 logits, SD = 2.13). Complementary to comparisons of the frequency of disability, comparison of the combined magnitude and strength of disability across countries provides new information that may better inform public health and policy decisions.

Measuring the interference of pain on daily life in persons with spinal cord injury: A Rasch-validated subset of items from the Brief Pain Inventory interference scale.

BACKGROUND/AIM: Up to 60% of individuals report chronic pain after traumatic spinal cord injury (SCI). Measurement of the degree to which pain interferes with activities and emotions can provide valuable clinical insights with implications for pain management interventions. One questionnaire that can be used to quantify the impact of pain is the Brief Pain Inventory (BPI) interference scale, a seven-item self-report assessment. Our objective was to examine the Rasch measurement properties of the BPI interference scale for measuring pain interference in persons with SCI. METHODS: A secondary analysis of cross-sectional, population-based, self-report data was conducted. Participants were adults with traumatic SCI with residual effects who were at least one year post-injury and 18 years of age (n = 876). Rasch analysis was used to evaluate the measurement properties of the BPI interference items for persons with SCI. RESULTS: Two BPI interference scale items were excluded from analysis due to high rates of missing data. Of the remaining five items, four items demonstrated acceptable measurement properties in the SCI population. CONCLUSION: Four of the original seven BPI interference items provide acceptable measurements of pain interference in the SCI population.

Linking existing instruments to develop a continuum of care measure: accuracy comparison using function-related group classification.

PURPOSES: To compare measurement accuracy of test forms with varied number of items (13, 8, and 4 items) generated from the self-care physical function item bank composed of Functional Independence Measure (FIM™) and the Minimum Data Set (MDS). METHODS: Retrospective data analysis of 2499 Veterans who completed both FIM and MDS within 6 days. We compared measurement accuracy between the converted FIM (FIMc) motor score generated from the MDS and the original FIM (FIMa) motor score (13 items) at: (a) individual-level using point differences, and (b) group-level using function-related group (FRG). RESULTS: The differences of mean FIMa and FIMc scores were between 0.05 and 1.07 points for all test forms. Over 81% of FIMc from MDS_13 were within 15 points of the FIMa. 81-90% of FRGs generated by the FIM short forms was identical to those generated by the FIMa for stroke, lower limb amputation, knee and hip replacement; and 59.9-90.5% by all MDS test forms. All MDS test forms had above 74% agreement with same or adjacent FMGs (ICC 0.65-0.91). CONCLUSIONS: The accuracy is dependent on the comparison level (i.e., individual or group), length of the test and which FRG is used. Our results partially support using existing instruments-without decreasing the number of the items-to generate a continuum of care measurement.

How Accurately Do Both Parents and Health Professionals Assess Overweight in Children?

BACKGROUND: An accurate perception of weight status is important to prevent childhood obesity. OBJECTIVE: We investigated whether parents and health professionals accurately identify children's weight status. METHODS: On the 2012 National Health and Nutrition Examination Survey: National Youth Fitness Survey, parents and health professionals rated the same child's weight status as overweight or healthy. The sensitivity and specificity of their answers were computed by comparing parents' and health professionals' ratings to the age growth chart from the US Centers for Disease Control and Prevention. RESULTS: Participants were 1571 children. Parents' sensitivity and specificity were 0.386 and 0.992, respectively. Health professionals' sensitivity and specificity were 0.343 and 0.981, respectively. CONCLUSIONS: Parents and health professionals demonstrate low sensitivity in identifying children's weight status. Health professionals should use the Centers for Disease Control and Prevention categories to more accurately identify children who are overweight.

Assessment of the psychometrics of a PROMIS item bank: self-efficacy for managing daily activities.

PURPOSE: The aim of this study is to investigate the psychometrics of the Patient-Reported Outcomes Measurement Information System self-efficacy for managing daily activities item bank. METHODS: The item pool was field tested on a sample of 1087 participants via internet (n = 250) and in-clinic (n = 837) surveys. All participants reported having at least one chronic health condition. The 35 item pool was investigated for dimensionality (confirmatory factor analyses, CFA and exploratory factor analysis, EFA), item-total correlations, local independence, precision, and differential item functioning (DIF) across gender, race, ethnicity, age groups, data collection modes, and neurological chronic conditions (McFadden Pseudo R (2) less than 10 %). RESULTS: The item pool met two of the four CFA fit criteria (CFI = 0.952 and SRMR = 0.07). EFA analysis found a dominant first factor (eigenvalue = 24.34) and the ratio of first to second eigenvalue was 12.4. The item pool demonstrated good item-total correlations (0.59-0.85) and acceptable internal consistency (Cronbach's alpha = 0.97). The item pool maintained its precision (reliability over 0.90) across a wide range of theta (3.70), and there was no significant DIF. CONCLUSION: The findings indicated the item pool has sound psychometric properties and the test items are eligible for development of computerized adaptive testing and short forms.

Dimensionality and Item-Difficulty Hierarchy of the Lower Extremity Fugl-Meyer Assessment in Individuals With Subacute and Chronic Stroke.

OBJECTIVE: To investigate the dimensionality and item-difficulty hierarchy of the Fugl-Meyer Assessment of the lower extremity (FMA-LE). DESIGN: Secondary analyses of data pooled from 4 existing datasets: a phase III randomized controlled trial investigating the effectiveness of body weight support and a treadmill for rehabilitation of walking poststroke, and 3 cross-sectional studies investigating the link between impaired motor performance poststroke and walking. SETTING: University research centers and rehabilitation centers. PARTICIPANTS: A pooled sample of individuals with a stroke (N=535, men=313; mean age ± SD, 61.91±12.42y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Confirmatory factor analyses (CFA) and Rasch residual principal component analysis (PCA) investigated the dimensionality of the FMA-LE. The Rasch analysis rating scale model investigated item-difficulty hierarchy of the FMA-LE. RESULTS: The CFA showed adequate fit of a 3-factor model, with 2 out of 3 indices (CFA=.95; Tucker-Lewis Index=.94; root mean square error of approximation=.124) showing good model fit. Rasch PCA showed that removal of the reflex and coordination items explained 90.8% of variance in the data, suggesting that the abnormal synergy items contributed to the measurement of a unidimensional construct. However, rating scale model results revealed deviations in the item-difficulty hierarchy of the unidimensional abnormal synergy items from the originally proposed stepwise sequence of motor recovery. CONCLUSIONS: Our findings suggest that the FMA-LE might represent a multidimensional construct, challenging the use of a total score of the FMA-LE to predict lower extremity motor recovery. Removal of the misfit items resulted in creation of a unidimensional scale composed of the abnormal synergy items. However, this unidimensional scale deviates from the originally proposed hierarchical ordering.

Factor structure and item level psychometrics of the Social Problem Solving Inventory-Revised: Short Form in traumatic brain injury.

Social problem-solving deficits characterise individuals with traumatic brain injury (TBI), and poor social problem solving interferes with daily functioning and productive lifestyles. Therefore, it is of vital importance to use the appropriate instrument to identify deficits in social problem solving for individuals with TBI. This study investigates factor structure and item-level psychometrics of the Social Problem Solving Inventory-Revised: Short Form (SPSI-R:S), for adults with moderate and severe TBI. Secondary analysis of 90 adults with moderate and severe TBI who completed the SPSI-R:S was performed. An exploratory factor analysis (EFA), principal components analysis (PCA) and Rasch analysis examined the factor structure and item-level psychometrics of the SPSI-R:S. The EFA showed three dominant factors, with positively worded items represented as the most definite factor. The other two factors are negative problem-solving orientation and skills; and negative problem-solving emotion. Rasch analyses confirmed the three factors are each unidimensional constructs. It was concluded that the total score interpretability of the SPSI-R:S may be challenging due to the multidimensional structure of the total measure. Instead, we propose using three separate SPSI-R:S subscores to measure social problem solving for the TBI population.

Relationship Between Physical Activity and Overweight and Obesity in Children: Findings From the 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey.

OBJECTIVE: This study examined the relationship between childhood obesity and overweight and functional activity and its enjoyment. METHOD: A cross-sectional design was used to analyze data from the 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey. Multivariate logistic regression models were used. RESULTS: Data for 1,640 children ages 3-15 yr were retrieved. Physical activity was negatively associated with risk of obesity (odds ratio [OR] = 0.93; 95% confidence interval [CI] [0.87, 0.98]). Although children who were obese and overweight were more likely to have functional limitations (ORs = 1.58-1.61), their enjoyment of physical activity participation was not significantly different from that of the healthy-weight group. CONCLUSION: Physical activity lowered the risk of obesity. Children who were obese had functional limitations compared with healthy-weight children, but both groups enjoyed physical activity equally. Future studies are needed to determine barriers to participation among these children in recreation and sporting activities.

Development of an Upper Extremity Function Measurement Model.

This study demonstrated the development of a measurement model for gross upper-extremity function (GUE). The dependent variable was the Rasch calibration of the 27 ICF-GUE test items. The predictors were object weight, lifting distance from floor, carrying, and lifting. Multiple regression was used to investigate the contribution that each independent variable makes to the model with 203 outpatients. Object weight and lifting distance were the only statistically and clinically significant independent variables in the model, accounting for 83% of the variance (p < 0.01). The model indicates that, with each one pound increase in object weight, item challenge increases by 0.16 (p < 0.00) logits, and with each one inch increase in distance lifted from floor, item challenge increased by 0.02 logits (p < 0.02). The findings suggest that the majority of the variance of the measurement model for the ICF-GUE can be explained by object weight and distance lifted from the floor.

Rasch Analysis of the Wrist and Hand Fugl-Meyer: Dimensionality and Item-Level Characteristics.

BACKGROUND AND PURPOSE: Clinical administration of the wrist stability, wrist mobility, and hand items of the upper-extremity Fugl-Meyer (W/H UE FM) may provide a rigorous, easily administered, bedside measure of motor impairment in mildly impaired stroke survivors. The purpose of this study was to evaluate the item structure of the W/H UE FM to better understand its measurement properties using Rasch analysis. METHODS: This was a secondary analysis of W/H UE FM data arising from clinical trials of mildly impaired stroke survivors using latent parallel analysis, ordinal factor analysis, and partial credit model Rasch analyses. RESULTS: Latent parallel analysis and ordinal factor analysis indicated that all W/H UE FM items represent a single unidimensional construct, wrist and hand motor ability. Rasch analysis of data from 150 mildly impaired stroke survivors (94 men; mean age, 57.1 ± 11.4 years; mean time since stroke, 19.5 months) revealed that the W/H UE FM operated as a reliable, valid, and effective measure of wrist and hand motor ability. These data were compatible with Rasch model assumptions and are consistent with previous W/H UE FM research. Mass flexion and extension movements were the least difficult W/H UE FM items while the radial and hook grasp items were the most difficult. DISCUSSION AND CONCLUSION: The W/H UE FM is well suited to mildly impaired stroke survivors who exhibit the ability to perform mass flexion and mass extension movements. The full-scale UE FM may be preferable for stroke survivors with lower levels of ability.Video abstract available for additional insight from the authors (Supplemental Digital Content 1, http://links.lww.com/JNPT/A108).

Psychometrics of the Fitness-to-Drive Screening Measure.

We employed item response theory (IRT), specifically using Rasch modeling, to determine the measurement precision of the Fitness-to-Drive Screening Measure (FTDS), a tool that can be used by caregivers and occupational therapists to help detect at-risk drivers. We examined unidimensionality through the factor structure (how items contribute to the central construct of fitness to drive), rating scale (use of the categories of the rating scale), item/person-level separation (distinguishing between items with different difficulty levels or persons with different ability levels) and reliability, item hierarchy (easier driving items advancing to more difficult driving items), rater reliability, rater effects (severity vs. leniency of a rater), and criterion validity of the FTDS to an on-road assessment, via three rater groups (n = 200 older drivers; n = 200 caregivers; n = 2 evaluators). The FTDS is unidimensional, the rating scale performed well, has good person (> 3.07) and item (> 5.43) separation, good person (> 0.90) and item reliability (> 0.97), with < 10% misfitting items for two rater groups (caregivers and drivers). The intraclass correlation (ICC) coefficient among the three rater groups was significant (.253, p < .001) and the evaluators were the most severe raters. When comparing the caregivers' FTDS rating with the drivers' on-road assessment, the areas under the curve (index of discriminability; caregivers .726, p < .001) suggested concurrent validity between the FTDS and the on-road assessment. Despite limitations, the FTDS is a reliable and accurate screening measure for caregivers to help identify at-risk older drivers and for occupational therapy practitioners to start conversations about driving.

Defining a universal measurement unit and scale for gross motor development.

Introduction: The ability of children to accomplish progressively more difficult gross motor tasks follows a predictable sequence that has been well documented as part of development. Current existing instruments were developed independently using classical test theory methods which led to the lack of a universal measurement scale and unit. The purpose of this study was to test a specification equation, anchored to commonly accepted and reproducible tasks in gross motor development, to generate a universal measurement scale and unit of measurement, called the Gross Motor (GM) unit. Methods: We rated component measures for each of the gross motor development tasks on the Gross Motor Function Measure-66 (GMFM). The GMFM is a gross motor development measure created with Rasch measurement theory to quantify observed difficulty levels measured on an interval scale. Component measures for body position, movement, and support were based on hypothesized contributions to gross motor development based on theory. Forward stepwise linear regression was used to test a specification equation. The specification equation was anchored to reference points to fix a unit size. Results: Our specification equation explained 87% of the variance in observed gross motor task difficulty. Predicted difficulty for gross motor tasks was strongly associated with observed task difficulty (r = 0.94, p < 0.0001). Our specification equation was anchored to 1) lying supine (0 GM units) and 2) walking unsupported (100 GM units) setting the size of the GM unit to 1/100 of the distance between lying supine and unsupported walking. Discussion: Our specification equation allows for experimental testing of gross motor development theories. This approach provides a framework for refining our understanding and measurement of gross motor development and creates a universal scale and unit. We expect that this will facilitate placing many, if not all, current gross motor development instruments on the same measurement scale.

Rasch analysis staging methodology to classify upper extremity movement impairment after stroke.

OBJECTIVES: To define Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) cutoff scores that demarcate 1 level of upper extremity (UE) impairment from another, and describe motor behaviors for each category in terms of expected FMA-UE item performance. DESIGN: Analysis of existing FMA-UE data. SETTING: University research laboratory. PARTICIPANTS: Persons (N=512) 0 to 145 days poststroke, 42 to 90 years of age. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: An item response Rasch analysis staging method was used to calculate cutoff scores, which were defined as the Rasch-Andrich threshold values of 2 criterion FMA-UE items derived from an analysis of this sample. The analysis enabled conversion of cutoff scores, in logit units, to FMA-UE points assessed on 30 FMA-UE voluntary movement items (60 possible points). RESULTS: The boundary between severe and moderate impairment was defined as -1.59 ± .27 logits or 19 ± 2 points; and between moderate and mild impairment was defined as 2.44 ± .27 logits or 47 ± 2 points. A description of expected performance in each impairment level shows that patients with severe impairment exhibited some distal movements, and patients with mild impairment had difficulties with some proximal movements. CONCLUSIONS: The cutoff scores, which link to a description of specific movements a patient can, can partially, and cannot perform, may enable formation of heterogeneous patient groups, advance efforts to identify specific movement therapy targets, and define treatment response in terms of specific movement that changed or did not change with therapy.

Generating clinical outputs for self-reports of visual functioning.

PURPOSE: Visual functioning questionnaires (VFQs) address patient-centered and evidenced-based practice. The purpose of this study was to investigate the psychometrics of the Self-Report Assessment of Functional Vision Performance (SRAFVP) and present Rasch-generated patient-level outputs. METHODS: One hundred two patients were administered the 39-item SRAFVP that includes questions under the categories of reading, writing, money management, telephone usage, reading a timepiece, personal care, clothing care, meal preparation, leisure, and functional mobility. Dimensionality was determined using confirmatory factor analysis and principal components analysis of residuals. The Andrich rating (Rasch) model was used to determine rating scale qualities, item/person fit to the Rasch model, item-difficulty hierarchy, person-item match, and person separation. Keyform outputs were generated that present response patterns for individual patients. RESULTS: Whereas the confirmatory factor analysis confirmed reading and mobility dimensions, the principal components analysis indicated that the SRAFVP formed a single dominant measure. The original five-point rating scale showed disordered thresholds that were corrected by collapsing the three middle rating categories. Only two of 39 items showed high infit and outfit statistics and five of 39 items showed high outfit statistics. The items showed a logical item-difficulty order related to the visual ability necessary to accomplish activities of daily living. The SRAVFP separated the sample into 3.77 distinct strata, showing no ceiling or floor effects. Keyforms demonstrated distinct patterns of responses for individuals reporting different visual functioning ability. CONCLUSIONS: As with many VFQs, the SRAVFP shows good item-level psychometric qualities. The SRAVFP and other VFQs may provide the foundation for theory-based instrument calibration that should enhance our translation of measures across VFQs and improve our understanding of visual functioning. Rasch measurement provides a means to generate outputs that may prove to be useful in goal setting and treatment planning when providing low-vision rehabilitation.