Validation of the Machine Learning-Based Stroke Impact Scale With a Cross-Cultural Sample.

IMPORTANCE: The machine learning-based Stroke Impact Scale (ML-SIS) is an efficient short-form measure that uses 28 items to provide domain scores comparable to those of the original 59-item Stroke Impact Scale-Third Edition (SIS 3.0). However, its utility is largely unknown because it has not been cross-validated with an independent sample. OBJECTIVE: To examine the ML-SIS's comparability and test-retest reliability with that of the original SIS 3.0 in an independent sample of people with stroke. DESIGN: Comparability was examined with the coefficient of determination (R2), mean absolute error, and root-mean-square error (RMSE). Test-retest reliability was examined using the intraclass correlation coefficient (ICC). SETTING: Five hospitals in Taiwan. PARTICIPANTS: Data of 263 persons with stroke were extracted from a previous study; 144 completed repeated assessments after a 2-wk interval. RESULTS: High R2 (.87-.95) and low mean absolute error or RMSE (about 2.4 and 3.3) of the domain scores, except for the Emotion scores (R2 = .08), supported the comparability of the two measures. Similar ICC values (.39-.87 vs. .46-.87) were found between the two measures, suggesting that the ML-SIS is as reliable as the SIS 3.0. CONCLUSIONS AND RELEVANCE: The ML-SIS provides scores mostly identical to those of the original measure, with similar test-retest reliability, except for the Emotion domain. Thus, it is a promising alternative that can be used to lessen the burden of routine assessments and provide scores comparable to those of the original SIS 3.0. Plain-Language Summary: The machine learning-based Stroke Impact Scale (ML-SIS) is as reliable as the original Stroke Impact Scale-Third Edition, except for the Emotion domain. Thus, the ML-SIS can be used to improve the efficiency of clinical assessments and also relieve the burden on people with stroke who are completing the assessments.

Inter- and Intrarater Reliability of the Gap-Kalamazoo Communication Skills Assessment Form Among Occupational Therapy Interns.

IMPORTANCE: Effective communication skills (CS) are essential for occupational therapists. The Gap-Kalamazoo Communication Skills Assessment Form (GKCSAF) is a standard tool for assessing the CS of medical residents. However, the interrater reliability for the nine CS domain scores ranges from poor to good. The intrarater reliability remains unclear. OBJECTIVE: To examine the inter- and intrarater reliability of the GKCSAF's nine domain scores and total score among occupational therapy interns. DESIGN: Repeated assessments with the GKCSAF. SETTING: Medical center psychiatry department. PARTICIPANTS: Twenty-five interns and 49 clients with mental illness, recruited from August 2020 to December 2021. OUTCOMES AND MEASURES: The transcripts of 50 evaluation interviews between clients and interns were used. Three independent raters assessed each transcript twice, at least 3 mo apart. RESULTS: The GKCSAF demonstrated poor interrater reliability for the nine domain scores (weighted κ = .08-.30) and the total score (intraclass correlation coefficient [ICC] = .22, 95% confidence interval [CI] [.10, .35]). The GKCSAF showed poor to intermediate intrarater reliability for the nine domain scores (weighted κ = .27-.73) and fair reliability for the total score (ICC = .69, 95% CI [.60, .77]). CONCLUSIONS AND RELEVANCE: The GKCSAF demonstrates poor interrater reliability and poor to intermediate intrarater reliability for the nine domain scores. However, it demonstrates fair intrarater reliability in assessing the overall CS performance of occupational therapy interns. Significant variations were observed when different raters assessed the same interns' CS, indicating inconsistencies in ratings. Consequently, it is advisable to conservatively interpret the CS ratings obtained with the GKCSAF. Plain-Language Summary: It is essential for occupational therapists to effectively communicate with clients. The Gap-Kalamazoo Communication Skills Assessment Form (GKCSAF) is a standard tool that is used to assess the communication skills of medical residents. The study authors used the GKCSAF with occupational therapy interns in a medical center psychiatry department to assess how effectively they interviewed clients with mental illness. This study aids occupational therapy personnel in the interpretation of GKCSAF results. The study findings also highlight the importance of developing reliable and standardized measures to assess communications skills in the field of occupational therapy.

Test-Retest Reliability and Responsiveness of the Computerized Adaptive Test of Social Functioning in Persons With Stroke.

OBJECTIVE: To examine the test-retest reliability, minimal detectable change (MDC), responsiveness, and efficiency of the Computerized Adaptive Test of Social Functioning (Social-CAT) in patients with stroke. DESIGN: Repeated-assessments design. SETTING: A department of rehabilitation of a medical center. PARTICIPANTS: In total, 31 patients with chronic stroke and 65 patients with subacute stroke were recruited. INTERVENTION: Not available. MAIN OUTCOME MEASURE: Social-CAT. RESULTS: The Social-CAT showed acceptable test-retest reliability (intraclass correlation coefficient, 0.80) and small random measurement error (MDC%: 18.0%). However, heteroscedasticity was found (r between the means and the absolute change scores: 0.32), so the MDC% adjusted cut-off score is recommended for determining real improvement. Regarding responsiveness, the Social-CAT showed large differences (Kazis' effect size and standardized mean response: 1.15 and 1.09, respectively) in subacute patients. Regarding efficiency, the Social-CAT required an average of 5 items and less than 2 minutes for completion. CONCLUSIONS: Our findings indicate that the Social-CAT is a reliable and efficient measure with good test-retest reliability, small random measurement error, and good responsiveness. Thus, the Social-CAT is a useful outcome measure for routine monitoring of the changes in social function of patients with stroke.

Development of a Rasch-Calibrated Test for Assessing Implied Meaning in Patients With Schizophrenia.

IMPORTANCE: Patients with schizophrenia tend to have severe deficits in theory of mind, which may limit their interpretation of others' behaviors and thereby hamper social participation. Commonly used measures of theory of mind assess the ability to understand various social situations (e.g., implied meaning or hinting, faux pas), but these measures do not yield valid, reliable, and gender unbiased results to inform interventions for managing theory-of-mind deficits. We used understanding of implied meaning, which appears to be a unidimensional construct highly correlated with social competence, as a promising starting point to develop a theory-of-mind assessment. OBJECTIVE: To develop a Rasch-calibrated computerized test of implied meaning. DESIGN: Cross-sectional design. SETTING: Psychiatric hospitals and community. PARTICIPANTS: 344 participants (240 patients with schizophrenia and 104 healthy adults). RESULTS: We initially developed 27 items for the Computerized Implied Meaning Test. After inappropriate items (12 misfit items and 1 gender-biased item) were removed, the remaining 14 items showed acceptable model fit to the Rasch model (infit = 0.84-1.16; outfit = 0.65-1.34) and the one-factor model (comparative fit index = .91, standardized root mean square residual = .05, root-mean-square error of approximation = .08). Most patients (81.7%) achieved individual Rasch reliability of ≥.90. Healthy participants performed significantly better on the test than patients with schizophrenia (Cohen's d = 2.5, p < .001). CONCLUSIONS AND RELEVANCE: Our preliminary findings suggest that the Computerized Implied Meaning Test may provide reliable, valid, and gender-unbiased results for patients with schizophrenia. What This Article Adds: We developed a new measure for assessing theory-of-mind ability in patients with schizophrenia that consists of items targeting the understanding of implied meaning. Preliminary findings suggest that the Computerized Implied Meaning Test is reliable, valid, and gender unbiased and may be used in evaluating patients' theory-of-mind deficits and relevant factors.

Reliability of the performance-based measure of executive functions in people with schizophrenia.

BACKGROUND: The Performance-based measure of Executive Functions (PEF) with four domains is designed to assess executive functions in people with schizophrenia. The purpose of this study was to examine the test-retest reliability of the PEF administered by the same rater (intra-rater agreement) and by different raters (inter-rater agreement) in people with schizophrenia and to estimate the values of minimal detectable change (MDC) and MDC%. METHODS: Two convenience samples (each sample, n = 60) with schizophrenia were conducted two assessments (two weeks apart). The intraclass correlation coefficient (ICC) was analyzed to examine intra-rater and inter-rater agreements of the test-retest reliability of the PEF. The MDC was calculated through standard error of measurement. RESULTS: For the intra-rater agreement study, the ICC values of the four domains were 0.88-0.92. The MDC (MDC%) of the four domains (volition, planning, purposive action, and perfromance effective) were 13.0 (13.0%), 12.2 (16.4%), 16.2 (16.2%), and 16.3 (18.8%), respectively. For the inter-rater agreement study, the ICC values of the four domains were 0.82-0.89. The MDC (MDC%) were 15.8 (15.8%), 17.4 (20.0%), 20.9 (20.9%), and 18.6 (18.6%) for the volition, planning, purposive action, and performance effective domains, respectively. CONCLUSIONS: The PEF has good test-retest reliability, including intra-rater and inter-rater agreements, for people with schizophrenia. Clinicians and researchers can use the MDC values to verify whether an individual with schizophrenia shows any real change (improvement or deterioration) between repeated PEF assessments by the same or different raters.

Interrater and Intrarater Reliability of the Balance Computerized Adaptive Test in Patients With Stroke.

OBJECTIVE: To examine the interrater and intrarater reliability of the Balance Computerized Adaptive Test (Balance CAT) in patients with chronic stroke having a wide range of balance functions. DESIGN: Repeated assessments design (1wk apart). SETTING: Seven teaching hospitals. PARTICIPANTS: A pooled sample (N=102) including 2 independent groups of outpatients (n=50 for the interrater reliability study; n=52 for the intrarater reliability study) with chronic stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Balance CAT. RESULTS: For the interrater reliability study, the values of intraclass correlation coefficient, minimal detectable change (MDC), and percentage of MDC (MDC%) for the Balance CAT were .84, 1.90, and 31.0%, respectively. For the intrarater reliability study, the values of intraclass correlation coefficient, MDC, and MDC% ranged from .89 to .91, from 1.14 to 1.26, and from 17.1% to 18.6%, respectively. CONCLUSIONS: The Balance CAT showed sufficient intrarater reliability in patients with chronic stroke having balance functions ranging from sitting with support to independent walking. Although the Balance CAT may have good interrater reliability, we found substantial random measurement error between different raters. Accordingly, if the Balance CAT is used as an outcome measure in clinical or research settings, same raters are suggested over different time points to ensure reliable assessments.

Prediction of lower extremity motor recovery in persons with severe lower extremity paresis after stroke.

OBJECTIVE: To investigate the extent of motor recovery and predict the prognosis of lower extremity (LE) recovery in patients with severe LE paresis after stroke Methods: 137 patients with severe LE paresis after stroke were recruited from a local medical centre. Voluntary LE movement was assessed with the LE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-LE). Univariate and stepwise regression analyses were used to investigate 25 clinical variables (including demographic, neuroimaging, and behavioural variables) for finding the predictors of LE recovery. RESULTS: The STREAM-LE at discharge (DCSTREAM-LE) of the participants covered a very wide range (0-19). Specifically, 5.1% of the participants were nearly completely recovered, 11.7% were moderately recovered, 36.5% were slightly recovered, and 46.7% remained severely paralysed. 'Score of STREAM-LE at admission (ADSTREAM-LE)' and 'volume of lesion and oedema') were significant predictors of LE movement at discharge, explaining 25.1% of the variance of the DCSTREAM-LE (p < 0.001). CONCLUSIONS: LE motor recovery varied widely in our participants, indicating that patients' recovery might not follow simple rules. The low predictive power (about a quarter) indicates that LE motor recovery in patients with severe LE paresis after stroke was hardly predictive.

Validation and Establishment of an Interval-Level Measure of the Balance Assessment in Sitting and Standing Positions in Patients With Stroke.

OBJECTIVE: To validate the psychometric properties of the Balance Assessment in Sitting and Standing Positions, including validity (unidimensionality and concurrent validity), reliability (Rasch reliability), and responsiveness (compared with the Postural Assessment Scale for Stroke Patients [PASS]) and to transform the Balance Assessment in Sitting and Standing Positions from an ordinal-level measure into an interval-level measure. DESIGN: Retrospective cross-sectional study. SETTING: Medical records from a medical center. PARTICIPANTS: Patients with stroke (N=1193). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The 4-item Balance Assessment in Sitting and Standing Positions was used, assessing static sitting balance, dynamic sitting balance, static standing balance, and dynamic standing balance. RESULTS: Data of 1193 patients with stroke were included for Rasch analysis. The 4 items of the Balance Assessment in Sitting and Standing Positions constituted a unidimensional construct (infit/outfit mean square, .75-1.05), had good concurrent validity (r=.70-.90), and had sufficient Rasch reliability (.93). The Balance Assessment in Sitting and Standing Positions had large responsiveness (effect size, 1.20; standardized response mean, 1.51) and was comparable with the PASS (effect size, .90; standardized response mean, 1.32). CONCLUSIONS: The Balance Assessment in Sitting and Standing Positions has sound psychometric properties. The transformed-Rasch scores of the Balance Assessment in Sitting and Standing Positions can be used to identify patients' balance function and detect patients' changes.

Reliability and responsiveness of the activities of daily living computerized adaptive testing system in patients with stroke.

OBJECTIVE: To examine the intrarater reliability, interrater reliability, and responsiveness of the Activities of Daily Living Computerized Adaptive Testing system (ADL CAT) in patients with stroke. DESIGN: One repeated-measures design (at an interval of 7d) was used to examine the intrarater reliability and interrater reliability of the ADL CAT. For the responsiveness study, participants were assessed with the ADL CAT at admission to the rehabilitation ward and at discharge from the hospital. SETTING: Eight rehabilitation units. PARTICIPANTS: Three different (nonoverlapping) groups of patients (N=157) were recruited. Fifty-five and 42 outpatients with chronic stroke participated in the intrarater and interrater reliability studies, respectively; 60 inpatients who had recently had a stroke participated in the responsiveness study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE ADL CAT RESULTS: The intraclass correlation coefficient values were .94 and .80 for the ADL CAT in the intrarater reliability and interrater reliability studies, respectively. The classical test theory-based minimal detectable change values were 6.5 and 9.5 for the ADL CAT in the intrarater reliability and interrater reliability studies, respectively. The Kazis' effect size and standardized response mean of the ADL CAT were moderate (.62-.73). CONCLUSIONS: The ADL CAT has good intrarater reliability and interrater reliability in outpatients with chronic stroke, and sufficient responsiveness in inpatients with stroke undergoing inpatient rehabilitation. Further investigations on the responsiveness of the ADL CAT in outpatients are needed to obtain more evidence on the utility of the ADL CAT.

Practice effects and test-re-test reliability of the Five Digit Test in patients with stroke over four serial assessments.

OBJECTIVES: To investigate practice effect and test-re-test reliability of the Five Digit Test (FDT) over four serial assessments in patients with stroke. DESIGN: Single-group repeated measures design. METHODS: Twenty-five patients with stroke were administered the FDT in four consecutive assessments every 2 weeks. The FDT contains four parts with five indices: 'basic measures of attention and processing speed', 'selective attention', 'alternating attention', 'ability of inhibition' and 'ability of switching'. RESULTS: The five indices of the FDT showed trivial-to-small practice effects (Cohen's d = 0.03-0.47) and moderate-to-excellent test-re-test reliability (intra-class correlation coefficient = 0.59-0.97). Practice effects of the five indices all appeared cumulative, but one index, 'basic measures of attention and processing speed', reached a plateau after the second assessment. The minimum and maximum values of the 90% confidence interval (CI) of reliable change index modified for practice (RCIp) for this index were [-17.6, 11.2]. CONCLUSIONS: One of five indices of the FDT reached a plateau, whose minimum and maximum values of the 90% CI RCIp are useful to determine whether the change in an individual's score is real. However, clinicians and researchers should be cautious when interpreting the test results of these four indices over repeated assessments.

Tests of data quality, scaling assumptions, reliability, and construct validity of the SF-36 health survey in people who abuse heroin.

BACKGROUND/PURPOSE: Health-related quality of life (HRQOL) is considered an important outcome indicator in substances abuse studies. However, psychometric properties of HRQOL measures are largely unknown in people who abuse heroin. Therefore, the present study aimed to examine data quality, scaling properties, reliability, and construct validity of the 36-Item Short Form healthy survey (SF-36) in people who abuse heroin. METHODS: A total of 469 people who abuse heroin participated in the study. Data quality was determined by data completeness. Scaling properties were evaluated by item frequency distribution, equivalence of item means and standard deviations, item-internal consistency, and item-discriminant validity (calculating scaling success). Internal consistency was examined using Cronbach's α. Construct validity was examined by investigating convergent validity and divergent validity among the eight scales of the SF-36. RESULTS: The results of data quality showed low missing rates (0.0-3.8%) and high completion rates in the scales (91.9-98.7%). The results of scaling assumptions showed good item frequency distribution on each item, roughly equivalent item means and standard deviations within a scale, good item-internal consistency (>0.4) and good scaling success rates (77.5-100%), except on the two scales of bodily pain (BP) and social functioning (SF). Three scales showed ceiling and/or floor effects [i.e., physical functioning (PF), role limitations due to physical problems (RP), and role limitations due to emotional problems (RE)]. Cronbach's α was acceptable (>0.7), except for the BP and SF scales. Construct validity was partially supported by the results of convergent validity and divergent validity. CONCLUSION: The results confirmed good data quality; satisfactory scaling assumptions and internal consistency (except for the BP and SF scales); and generally acceptable construct validity. However, the PF, RP, and RE scales showed ceiling and/or floor effects. Therefore, the BP, SF, PF, RP, and RE scales should be used with cautions in measuring HRQOL in people who abuse heroin.

Developing an Accumulative Assessment System of Upper Extremity Motor Function in Patients With Stroke Using Deep Learning.

OBJECTIVE: The Fugl-Meyer assessment for upper extremity (FMA-UE) is a measure for assessing upper extremity motor function in patients with stroke. However, the considerable administration time of the assessment decreases its feasibility. This study aimed to develop an accumulative assessment system of upper extremity motor function (AAS-UE) based on the FMA-UE to improve administrative efficiency while retaining sufficient psychometric properties. METHODS: The study used secondary data from 3 previous studies having FMA-UE datasets, including 2 follow-up studies for subacute stroke individuals and 1 test-retest study for individuals with chronic stroke. The AAS-UE adopted deep learning algorithms to use patients' prior information (ie, the FMA-UE scores in previous assessments, time interval of adjacent assessments, and chronicity of stroke) to select a short and personalized item set for the following assessment items and reproduce their FMA-UE scores. RESULTS: Our data included a total of 682 patients after stroke. The AAS-UE administered 10 different items for each patient. The AAS-UE demonstrated good concurrent validity (r = 0.97-0.99 with the FMA-UE), high test-retest reliability (intra-class correlation coefficient = 0.96), low random measurement error (percentage of minimal detectable change = 15.6%), good group-level responsiveness (standardized response mean = 0.65-1.07), and good individual-level responsiveness (30.5%-53.2% of patients showed significant improvement). These psychometric properties were comparable to those of the FMA-UE. CONCLUSION: The AAS-UE uses an innovative assessment method, which makes good use of patients' prior information to achieve administrative efficiency with good psychometric properties. IMPACT: This study demonstrates a new assessment method to improve administrative efficiency while retaining psychometric properties, especially individual-level responsiveness and random measurement error, by making good use of patients' basic information and medical records.

Test of Everyday Attention in patients with chronic stroke: test-retest reliability and practice effects.

OBJECTIVE: To examine the measurement properties of Test of Everyday Attention (TEA) in patients with chronic stroke including: test-retest reliability between parallel forms (i.e. forms AB, BC and CA), practice effect and critical values for detecting true change corrected for practice effect and measurement error. METHODS: Ninety patients with chronic stroke (months since onset > 6) were randomly assigned to receive forms AB, BC or CA of the TEA in a counterbalanced order. A test-retest design was used with a 1-week interval. RESULTS: All TEA sub-tests had good-to-excellent test-retest reliability among the three parallel forms except the Telephone Search While Counting (ICC = 0.51-0.59). Small practice effects were observed for almost all sub-tests. The reliable change index corrected for practice effect (RCIp) was provided for each sub-test. CONCLUSIONS: Most TEA sub-tests show promise as reliable measures of attention for repeated use with the parallel forms in patients with chronic stroke. Practice effects must be considered to interpret an individual change in clinical settings. Therefore, the value of RCIp provides a conservative estimate of a patient's progress, representing the smallest change in the TEA score that could be interpreted as true change, corrected for practice effects and measurement error.

Validation of two short forms of Stroke Impact Scale: unidimensionality and reliability.

PURPOSE: We examined the unidimensionality and Rasch reliability of both Jenkinson's and MacIsaac's eight-item short versions of the Stroke Impact Scale (SF-SIS), a questionnaire for assessing overall health-related quality of life (HRQOL). METHODS: This study was a secondary data analysis in which 263 persons with stroke completed the SIS. The 263 persons, on average, had age of 60 years, mild stroke, and moderate disability of self-care. The unidimensionality of both versions was validated via testing of model fitting and principal component analysis (PCA) of residuals using the Rasch analysis to determine the Rasch reliability and measures. RESULTS: The eight items in both SF-SIS versions met the criteria of infit and outfit MNSQ (<1.4 and >0.6), indicating good data-model fit. The PCA showed that no dominant factors existed in the residuals of the items. The person reliability of Jenkinson's and MacIsaac's SF-SIS versions was 0.80 and 0.79, respectively. The Rasch measures (i.e., person measure in logits) ranged from -1.06 to 1.87 in Jenkinson's SF-SIS and -0.82 to 1.88 in MacIsaac's version. CONCLUSIONS: The unidimensionality of both versions was supported. The Rasch measures of both appear valid for representing overall HRQOL levels. Both versions also showed acceptable reliability for research purposes.Implications for rehabilitationThe unidimensionality was justified for both versions (Jenkinson's and MacIsaac's eight-item short-versions of Stroke Impact Scale).The Rasch scores of both versions appear valid for representing overall health-related quality of life.Both versions showed acceptable reliability for research purposes, but not sufficiently reliable for clinical use.

Test-retest reliabilities and minimal detectable changes of 5 versions of the Alzheimer's Disease Assessment Scale-Cognitive Subscale in people with dementia.

PURPOSE: To compare the test-retest reliability and minimal detectable change (MDC) of the commonly used versions of the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) (the ADAS-Cog-11 (11 items), ADAS-Cog-3 (three items), ADAS-Cog-5-Subset (five items), ADAS-Cog-6-Subset (six items), and ADAS-Rasch (11 items)) in people with dementia. MATERIALS AND METHODS: A repeated-assessments design (2 weeks apart) was used to examine the ADAS-Cog-11, ADAS-Cog-3, ADAS-Cog-5-Subset, ADAS-Cog-6-Subset, and ADAS-Rasch. Participants with dementia were recruited from one hospital, one elder care center, and two day-care centers using convenience sampling. RESULTS: Fifty-two participants finished the assessments twice in two weeks. All versions showed high intraclass correlation coefficients (ICCs) (0.82-0.96), minimal standardized response means (-0.07 to 0.08) and low to acceptable MDC% (9.2-28.6%). The ADAS-Rasch had the highest ICC (0.96) and the lowest MDC%. The ADAS-Cog-3 had an ICC lower than 0.90 (0.82) and the highest MDC% (28.6%). CONCLUSIONS: The ADAS-Rasch seems to be the most reliable version of the ADAS-Cog for group- and individual-level comparisons. The ADAS-Cog-3 may be a better choice for researchers for group-level comparisons because it requires fewer items to achieve acceptable reliability. The ADAS-Cog-11, ADAS-Cog-5-Subset, ADAS-Cog-6-Subset, and ADAS-Rasch could be considered for clinical usage for individual-level comparisons.Implications for rehabilitationThe ADAS-Rasch is the most reliable version of the ADAS-Cog for group- and individual-level comparisons due to its excellent test-retest reliability, lowest random measurement error and absence of a practice effect.The ADAS-Cog-5-Subset and ADAS-Cog-6-Subset might be good substitutes for the ADAS-Rasch in clinical settings because of their comparable reliability features and superior administration efficiency.

Development of a Rasch-calibrated emotion recognition video test for patients with schizophrenia.

Patients with schizophrenia tend to have deficits in emotion recognition (ER) that affect their social function. However, the commonly-used ER measures appear incomprehensive, unreliable and invalid, making it difficult to comprehensively evaluate ER. The purposes of this study were to develop the Computerized Emotion Recognition Video Test (CERVT) evaluating ER ability in patients with schizophrenia. This study was divided into two phases. First, we selected candidate CERVT items/videos of 8 basic emotion domains from a published database. Second, we validated the selected CERVT items using Rasch analysis. Finally, the 269 patients and 177 healthy adults were recruited to ensure the participants had diverse abilities. After the removal of 21 misfit (infit or outfit mean square > 1.4) items and adjustment of the item difficulties of the 26 items with severe differential item functioning, the remaining 217 items were finalized as the CERVT items. All the CERVT items showed good model fits with small eigenvalues (≤ 2) based on the residual-based principal components analysis for each domain, supporting the unidimensionality of these items. The 8 domains of the CERVT had good to excellent reliabilities (average Rasch reliabilities = 0.84-0.93). The CERVT contains items of the 8 basic emotions with individualized scores. Moreover, the CERVT showed acceptable reliability and validity, and the scores were not affected by examinees' gender. Thus, the CERVT has the potential to provide a comprehensive, reliable, valid, and gender-unbiased assessment of ER for patients with schizophrenia.

Development of a computerized adaptive testing system of the Fugl-Meyer motor scale in stroke patients.

OBJECTIVE: To develop a computerized adaptive testing system of the Fugl-Meyer motor scale (CAT-FM) to efficiently and reliably assess motor function in patients with stroke. DESIGN: First, a simulation study was used to develop and examine the psychometric properties of the CAT-FM. Second, a field study was employed to determine the administration efficiency of the CAT-FM. SETTING: One medical center and 1 teaching hospital. PARTICIPANTS: Patients' responses (n=301) were used for the simulation study; 49 patients participated in the field study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The 2 CAT-FM item banks (upper extremity and lower extremity) include 37 items from the original Fugl-Meyer scale. The reliability, validity, and responsiveness of the CAT-FM were determined by the simulation study. RESULTS: Two stopping rules (reliability ≥0.9 or an increase of reliability <.01 after testing an item) were used. The simulation study showed that the CAT-FM had high reliability (≥.93 for upper-extremity and lower-extremity subscales) and concurrent validity (Pearson r≥.91 for the upper-extremity and lower-extremity subscales and motor scale). The responsiveness was moderate (standardized response mean for the upper extremity=.67, lower extremity=.79, and motor=.77) for the 226 patients who completed both assessments at 14 and 90 days after stroke. The field study found that, on average, the time needed to administer the CAT-FM was 242 seconds with 4.7 items. CONCLUSIONS: The CAT-FM is an efficient, reliable, valid, and responsive clinical tool for assessing motor function in patients with stroke.

Consistency Analysis in Medical Empathy Intervention Research.

Various studies have examined the effectiveness of interventions to increase empathy in medical professionals. However, inconsistencies may exist in the definitions, interventions, and assessments of empathy. Inconsistencies jeopardize the internal validity and generalization of the research findings. The main purpose of this study was to examine the internal consistency among the definitions, interventions, and assessments of empathy in medical empathy intervention studies. We also examined the interventions and assessments in terms of the knowledge-attitude-behavior aspects. We conducted a literature search for medical empathy intervention studies with a design of randomized controlled trials and categorized each study according to the dimensions of empathy and knowledge-attitude-behavior aspects. The consistencies among the definitions, interventions, and assessments were calculated. A total of 13 studies were included in this study. No studies were fully consistent in their definitions, interventions, and assessments of empathy. Only four studies were partially consistent. In terms of knowledge-attitude-behavior aspects, four studies were fully consistent, two studies were partially consistent, and seven studies were inconsistent. Most medical empathy intervention studies are inconsistent in their definitions, interventions, and assessments of empathy, as well as the knowledge-attitude-behavior aspects between interventions and assessments. These inconsistencies may have affected the internal validity and generalization of the research results.

Construct validity of the stroke-specific quality of life questionnaire in ischemic stroke patients.

OBJECTIVES: To investigate the construct validity of the commonly used 8- and 12-domain versions of the Stroke-Specific Quality of Life (SS-QOL) with a first-order factor model. The better-fitted version was further evaluated by a second-order factor structure model in order to determine whether a summary score is justified. DESIGN: Cohort study. SETTING: Outpatient stroke clinic. PARTICIPANTS: Patients (N=388) with ischemic stroke. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: The SS-QOL. We first conducted confirmatory factor analysis (CFA) to evaluate the construct validity of the first-order 8- or 12-domain versions of the SS-QOL. The better-fitted version was then validated by investigating the second-order health-related quality of life (HRQOL) factor. RESULTS: The 12-domain version, but not the 8-domain version, had sufficient goodness of fit (χ(2)=2041.7, df=1061, χ(2)/df=1.9, comparative fit index [CFI]=0.98, Tucker-Lewis index [TLI]=0.98, and root mean square error of approximation=0.05). All items of the 12-domain version showed acceptable factor loadings (>0.40) and were retained. Furthermore, the second-order CFA fit indices of the 12 domains were acceptable (χ(2)=2630.3, df=1115, χ(2)/df=2.4, CFI=0.97, TLI=0.97, root mean square error of approximation=0.06), indicating that a summary score was justified for representing the overall status of HRQOL. CONCLUSIONS: Our results show that the construct validity of the 12-domain SS-QOL is well supported for measuring HRQOL in ischemic stroke patients. Thus, we recommend the 12-domain version of the SS-QOL for use in capturing the multiple impacts of stroke as well as overall HRQOL status on the basis of patients' perspectives.

Development of a set of functional hierarchical balance short forms for patients with stroke.

OBJECTIVE: To develop a set of 3 hierarchical balance short forms (HBSF; containing sitting, standing, and stepping forms) to measure balance function in patients with stroke. DESIGN: First, we developed the HBSF, based on a previous data set, with each short form containing 6 items. Second, we examined the psychometric properties and efficiency of the HBSF. SETTING: Six teaching hospitals. PARTICIPANTS: Patients with stroke (n=764) for the first part of this study; inpatients and outpatients (n=85) for the second part of this study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We used the item bank (9 sitting-related, 14 standing-related, and 13 stepping-related items) from the Balance Computerized Adaptive Test to develop the HBSF. Both the HBSF and the Berg Balance Scale (BBS) were administered to patients, to determine the concurrent validity and time needed for administration of both measures. Each patient was assessed by 1 of the 3 short forms selected by a rater. RESULTS: The reliability of the HBSF was relatively high (reliability coefficients, .94-.95). The scores of the HBSF were highly correlated with those of the BBS (Spearman ρ=.80-.91), supporting the concurrent validity of the HBSF. The average time needed to administer the HBSF was 122 seconds (ie, about 40% of that for the BBS). CONCLUSIONS: Our results provide sufficient evidence that the HBSF is an efficient, reliable, valid, and practical way to measure balance function in patients with stroke.