Applying multidimensional computerized adaptive testing to the MSQOL-54: a simulation study.

BACKGROUND: The Multiple Sclerosis Quality of Life-54 (MSQOL-54) is one of the most commonly-used MS-specific health-related quality of life (HRQOL) measures. It is a multidimensional, MS-specific HRQOL inventory, which includes the generic SF-36 core items, supplemented with 18 MS-targeted items. Availability of an adaptive short version providing immediate item scoring may improve instrument usability and validity. However, multidimensional computerized adaptive testing (MCAT) has not been previously applied to MSQOL-54 items. We thus aimed to apply MCAT to the MSQOL-54 and assess its performance. METHODS: Responses from a large international sample of 3669 MS patients were assessed. We calibrated 52 (of the 54) items using bifactor graded response model (10 group factors and one general HRQOL factor). Then, eight simulations were run with different termination criteria: standard errors (SE) for the general factor and group factors set to different values, and change in factor estimates from one item to the next set at < 0.01 for both the general and the group factors. Performance of the MCAT was assessed by the number of administered items, root mean square difference (RMSD), and correlation. RESULTS: Eight items were removed due to local dependency. The simulation with SE set to 0.32 (general factor), and no SE thresholds (group factors) provided satisfactory performance: the median number of administered items was 24, RMSD was 0.32, and correlation was 0.94. CONCLUSIONS: Compared to the full-length MSQOL-54, the simulated MCAT required fewer items without losing precision for the general HRQOL factor. Further work is needed to add/integrate/revise MSQOL-54 items in order to make the calibration and MCAT performance efficient also on group factors, so that the MCAT version may be used in clinical practice and research.

Prescribing pattern of anticoagulants in patients with cancer associated thrombosis: Results of a survey among MITO group and AIOM society.

INTRODUCTION: Low molecular weight heparin (LMWH) has been the backbone of the treatment of cancer associated thrombosis (CAT). Direct-acting oral anticoagulants (DOACs) have shown efficacy and safety not inferior to LMWH and guidelines included DOACs as an option for CAT treatment. Nevertheless, DOACs are still poorly prescribed in patients with cancer. The aim of this survey was to better understand prescription patterns of anticoagulants, in particular of DOACs, especially in gynecological cancers (GCs). METHODS: Our survey was made up of 21 questions, the last four questions addressed to medical doctors (MDs) involved in GCs. An invitation to complete the survey was sent by e-mail to 691 MITO (Multicentre Italian Trials in Ovarian cancer and gynaecologic malignancies) and 2093 AIOM (Associazione Italiana di Oncologia Medica) members. RESULTS: Overall, 113 MDs completed the questionnaire, 69 involved in GCs. Most respondents (46, 41%) were aged 30-40 years old, worked in public hospitals (59, 52.2%), were medical oncologists (86, 76.1%). LMWH was the preferred choice for the treatment of CAT (104, 92%). However, 89 respondents (78.8%) prescribed or asked to prescribe a DOAC for CAT. The major concern about DOACs was the difficulty in verifying the therapeutic effect and the absence of antidotes in case of bleeding (37.9%). In patients with GCs, DOACs were used with niraparib, olaparib, rucaparib and immune checkpoint inhibitors (ICIs) in less than 10 patients by 23%, 20%, 9% and 10.2% of respondents, respectively. CONCLUSION: The responders are aware of the Direct-acting oral anticoagulants option and would like to use them.

Does Existential Flexibility Associate With Individuals' Acceptance of Inequality? A Study Relating Existential Questing to Values and to Prejudice.

This study investigated whether existential quest, a relatively new construct defining individual willingness to reflect on existential issues such as the meaning of life and death, was negatively associated with generalized prejudice through the mediation with personal values of universalism and conservation (conformity, security, and tradition). A structural equation model was performed on a convenience sample of 1136 Italian adults. Results confirmed a negative indirect relationship with generalized prejudice mediated by universalism. Findings support the argument that engagement with existential issues is associated with the value of universalism, which in turn is associated with lower levels of generalized prejudice. The present study contributes to the scholarly literature to explain the concept of existential quest.

Theory of Mind Development in Italian Children with Specific Language Impairment and Autism Spectrum Disorder: Delay, Deficit, or Neither?

Some studies report delayed theory of mind (ToM) development in children with specific language impairment (SLI), while others do not. A ToM delay is acknowledged in children with autism spectrum disorder (ASD), while whether these children also display a deficit is still under debate. In the current study, we drew on a developmental trajectory approach to assess whether children with SLI or ASD displayed delays or deficits in their ToM performance. Forty-three children with SLI (age 4-10 years), 44 children with ASD (age 5-12 years), and 227 typically developing children (age 3-11 years) completed the ToM Storybooks. Children with SLI were not found to display either a delay or a deficit in ToM, while children with ASD were found to display a deficit.

Acute kidney injury after liver transplantation, perioperative risk factors, and outcome: prospective observational study of 1681 patients (OLTx Study).

BACKGROUND: Acute kidney injury (AKI) represents a frequent complication after orthotopic liver transplantation (OLT). This study aimed to evaluate early postoperative AKI incidence during the first 72 h after OLT, perioperative risk factors, and AKI impact on survival. METHODS: From January 2011 to December 2013, 1681 patients underwent OLT in 19 centers and were enrolled in this prospective cohort study. RESULTS: According to RIFLE criteria, AKI occurred in 367 patients, 21.8% (R: 5.8%, I: 6.4%, F: 4.8%, L: 4.8%). Based on multivariate analysis, intraoperative risk factors for AKI were: administration of 5-10 RBCs (OR 1.8, 95% CI 1.3-2.7), dopamine use (OR 1.6, 95% CI 1.2-2.3), post-reperfusion syndrome (OR 1.5, 95% CI 1.0-2.3), surgical complications (OR 2.0, 95% CI 1.3-3.0), and cardiological complications (OR 2.2, 95% CI 1.2-4.0). Postoperative risk factors were: norepinephrine (OR 1.4, 95% CI 1.0-2.0), furosemide (OR 4.2, 95% CI 3.0-5.9), more than 10 RBCs transfusion, (OR 3.7, 95% CI 1.4-10.5), platelets administration (OR 1.6, 95% CI 1.1-2.4), fibrinogen administration (OR 3.0, 95% CI, 1.5-6.2), hepatic complications (OR 4.6, 95% CI 2.9-7.5), neurological complications (OR 2.4, 95% CI 1.5-3.7), and infectious complications (OR 2.7, 95% CI 1.8-4.3). NO-AKI patients' 5-year survival rate was higher than AKI patients (68.06, 95% CI 62.7-72.7 and 81.2, 95% CI 78.9-83.3, P<0.001). CONCLUSIONS: AKI still remains an important risk factor for morbidity and mortality after OLT. Further research to develop new strategies aimed at preventing or minimizing post-OLT AKI is needed.

Factor structure of post-operative quality of recovery questionnaire (QoR-15): An Italian adaptation and validation.

Background: The Quality of Recovery questionnaire (QoR-15) is an English instrument for measuring quality of recovery in surgical patients, not yet translated and validated in Italian when the Enhanced Recovery After Surgery (ERAS) Piemonte studies were planned. Objective: To produce the Italian version of the QoR-15 questionnaire, to evaluate its factorial structure and to assess the invariance between two types of surgery. Methods: The Italian version (QoR-15I) was obtained translating and adapting the original version to the Italian context. The validation was performed suppling the QoR-15I to 3,784 patients enrolled in two parallel stepped wedge cluster randomised trials (ERAS Colon-rectum Piemonte; ERAS Gyneco Piemonte). The factor structure and its invariance between types of surgery was tested using confirmatory bifactor model and multi-group analysis. Comparative fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR) fit indices and their changes between nested models were used to assess the factor structure and the invariance. Results: The bifactor model showed good fit (RMSEA = 0.049, CFI =0.957, SRMR = 0.036) and provided a general recovery factor and two specific factors for physical and mental recovery. Eighty-four percent of the common variance is attributable to the general factor, and thus the QoR-15I is sufficiently 'one-dimensional' with an adequate reliability (ωh = 0.70). The ωs values for the physical and mental recovery factors were 0.01 and 0.13, respectively. Multigroup analysis supported configural (RMSEA = 0.053, CFI = 0.950, SRMR = 0.035) and metric invariance (ΔRMSEA = -0.004; ΔCFI = -0.002; ΔSRMR = 0.014), whereas the intercept constraint was removed from item 15 to obtain partial scalar invariance (ΔRMSEA = 0.002; ΔCFI = 0.007; ΔSRMR = 0.004). Construct validity was supported by a negative association of QoR-15I scores with all variables related to worse patient condition and more complex surgery. Conclusion: Our results support the use of the QoR-15I as a valid, reliable, and clinically feasible tool for measuring the quality of recovery after surgery. The results of the confirmatory factor analyses suggest that a unique recovery score can be calculated and support measurement invariance of the QOR-15I across the two type of surgery, suggesting that the questionnaire has the same meaning and the same measurement parameters in colorectal and gynaecologic patients.

Viability of a MSQOL-54 general health-related quality of life score using bifactor model.

BACKGROUND: MSQOL-54 is a multidimensional, widely-used, health-related quality of life (HRQOL) instrument specific for multiple sclerosis (MS). Findings from the validation study suggested that the two MSQOL-54 composite scores are correlated. Given this correlation, it could be assumed that a unique total score of HRQOL may be calculated, with the advantage to provide key stakeholders with a single overall HRQOL score. We aimed to assess how well the bifactor model could account for the MSQOL-54 structure, in order to verify whether a total HRQOL score can be calculated. METHODS: A large international database (3669 MS patients) was used. By means of confirmatory factor analysis, we estimated a bifactor model in which every item loads onto both a general factor and a group factor. Fit of the bifactor model was compared to that of single and two second-order factor models by means of Akaike information and Bayesian information criteria reduction. Reliability of the total and subscale scores was evaluated with Mc Donald's coefficients (omega, and omega hierarchical). RESULTS: The bifactor model outperformed the two second-order factor models in all the statistics. All items loaded satisfactorily (≥ 0.40) on the general HRQOL factor, except the sexual function items. Omega coefficients for total score were very satisfactory (0.98 and 0.87). Omega hierarchical for subscales ranged between 0.22 to 0.57, except for the sexual function (0.70). CONCLUSIONS: The bifactor model is particularly useful when it is intended to acknowledge multidimensionality and at the same time take account of a single general construct, as the HRQOL related to MS. The total raw score can be used as an estimate of the general HRQOL latent score.

Self-efficacy, subjective well-being and positive coping in adolescents with regard to Covid-19 lockdown.

The study is aimed at examining the relationship between emotional and self-regulated learning self-efficacy, subjective well-being (SWB) and positive coping among adolescents and youths, during the COVID-19 pandemic lockdown. 485 Italian students (74% girls; mean age 19.3) filled in an online questionnaire during the lockdown period. The hypothesized model in which both the forms of self-efficacy were predictors of SWB and positive coping, and SWB partially mediated the relation between self-efficacy measures and positive coping was tested by means of Structural equation modeling. Results largely supported the hypothesized relationships and suggested paying special attention to adolescents' self-efficacy in regulating basic negative emotions, in order to promote positive coping strategies to face challenges coming from everyday life and from non-normative events.

Response shift in health-related quality of life measures in the presence of formative indicators.

BACKGROUND: Response shift (RS) has been defined as a change in the meaning of an individual's self-evaluation that needs to be accounted for when assessing longitudinal changes in health-related quality of life (HRQoL). RS detection through structural equation modeling is accomplished by adopting Oort's procedure based on a measurement model in which the observed variables are defined as reflective indicators of the HRQoL latent variable; that is, the latent variable causes the variation in the reflective indicators. This study aims to propose a procedure that assesses RS when formative indicators are used in measuring HRQoL; in this last case, the latent variable is considered to be a function of some formative indicators. A secondary aim is to compare the new procedure with Oort's procedure to highlight similarities and differences. METHODS: The data were retrieved from a consecutive series of 258 patients newly diagnosed with colorectal cancer and undergoing chemotherapy and/or surgery. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QOL-C30) was administered twice, once before and once six months after treatment. Structural equation modeling was used to evaluate RS and true change with the newly proposed method (in which fatigue and pain were defined as formative indicators) and with Oort's procedure (in which fatigue and pain were defined as reflective indicators). RESULTS: According to the new procedure, there was no measurement bias, and on average, patients' quality of life improved by 3.53 points (on a scale ranging from 0 to 100) at the 6-month follow-up. With Oort's procedure, the loading of the pain indicator was not invariant across the two time points, suggesting the presence of reprioritization, whereas the estimation of true change was very similar to the previous one: 3.87. CONCLUSIONS: RS and true change in HRQoL can be evaluated in the presence of formative indicators. Defining a measurement model by formative or reflective indicators can lead to different results.

Missing data in longitudinal studies: Comparison of multiple imputation methods in a real clinical setting.

RATIONALE, AIMS, AND OBJECTIVES: Missing data represent a challenge in longitudinal studies. The aim of the study is to compare the performance of the multivariate normal imputation and the fully conditional specification methods, using real data set with missing data partially completed 2 years later. METHOD: The data used came from an ongoing randomized controlled trial with 5-year follow-up. At a certain time, we observed a number of patients with missing data and a number of patients whose data were unobserved because they were not yet eligible for a given follow-up. Both unobserved and missing data were imputed. The imputed unobserved data were compared with the corresponding real information obtained 2 years later. RESULTS: Both imputation methods showed similar performance on the accuracy measures and produced minimally biased estimates. CONCLUSION: Despite the large number of repeated measures with intermittent missing data and the non-normal multivariate distribution of data, both methods performed well and was not possible to determine which was better.

Second-language learning difficulties in Italian children with reading difficulties.

BACKGROUND: Children with dyslexia often show second-language reading and writing difficulties, but the cognitive mechanisms connected to this impairment need to be clarified. AIMS: The present study examined the neuropsychological mechanisms underlying learning English as a foreign language in 4th- to the 8th-grade Italian students showing reading difficulties (RD) or typical development (TD). For this purpose, screening involving 901 students was carried out to select children with RD. SAMPLE: Ninety students with RD were compared with 90 typically developing (TD) children matched for non-verbal IQ, grade, and gender. METHODS: The two groups were compared on different measures to understand the relationships between reading skills in their mother tongue and in English as a second-language (L2). Subsequently, their phonological and memory skills were investigated to understand the potential role of these variables in learning L2 English. RESULTS: Students with RD obtained worse results than TD students for phonological awareness and working memory, which are both crucial to L2 learning. CONCLUSIONS: The results suggest that memory mainly influences accuracy in English writing and, together with phonological skills, plays an important role in reading accuracy. Socio-economic status also plays an important role in L2 learning.

Factorial Invariance and Orthogonal Rotation.

A large number of methods of factor rotation are available in the literature, but the development of formal criteria by which to compare them is an understudied field of research. One possible criterion is the Thurstonian concept of "factorial invariance", which was applied by Kaiser to the varimax rotation method in 1958 and has been subsequently neglected. In the present study, we propose two conditions for establishing whether a method satisfies factorial invariance, and we apply them to 11 orthogonal rotation methods. The results show that 3 methods do not exhibit factorial invariance under either condition, 3 are invariant under one but not the other, and 5 are invariant under both. Varimax rotation is one of the 5 methods that satisfy factorial invariance under both conditions and is the only method that satisfies the invariance condition originally advocated by Kaiser in 1958. From this perspective, it appears that varimax rotation is the method that best ensures factorial invariance.

Comparison between a flash glucose monitoring system and a portable blood glucose meter for monitoring dogs with diabetes mellitus.

BACKGROUND: Flash glucose monitoring system (FGMS; FreeStyle Libre) was recently validated for use in diabetic dogs (DD). It is not known if this system is clinically useful in monitoring DD. OBJECTIVE: To compare the clinical utility of FGMS against blood glucose curves (BGCs) obtained with a portable blood glucose meter (PBGM) in monitoring DD. ANIMALS: Twenty dogs with diabetes mellitus. METHODS: Prospective study. Dogs with diabetes mellitus on insulin treatment for at least 1 month were included. Comparisons of insulin dose recommendations based on the in-hospital GCs acquired using FGMS and a PBGM, consecutive-day interstitial GCs (IGCs) acquired at home using the FGMS, and consecutive-day, home vs hospital IGCs acquired using the FGMS were made using concordance analysis. RESULTS: There was good concordance between insulin dose recommendations based on FGMS and PBGM generated GCs and IGCs obtained in the 2 different environments on 2 consecutive days, but almost absent concordance between IGCs obtained on 2 consecutive days at home. Glucose nadirs were detected in 34/43 (79%) of Ambulatory Glucose Profile (AGP) reports of the FGMS. In comparison, concordant glucose nadirs were identified in 14/34 (41%) BGCs using PBGM. The individual FGMS scans and PBGM identified 60% and 9% of low IG/hypoglycemic episodes, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Insulin dose adjustments based on BGCs can be suboptimal. The FGMS allows a more accurate identification of the glucose nadirs and hypoglycemic episodes compared to the use of a PBGM and assessment of day-to-day variations in glycemic control.

Flashbulb memory: referring back to Brown and Kulik's definition.

Since Brown and Kulik's (1977. Flashbulb memories. Cognition, 5, 73-99. http://doi.org/10.1016/0010-0277(77)90018-X) seminal work, a central issue in memory literature is whether flashbulb memories (FBMs) hold a special status within autobiographical recalls. To address this issue, we refer back to Brown and Kulik's definition of FBM as a snapshot of the reception context of an important public news and propose a method to identify the contents of this snapshot. Although Brown and Kulik found that the majority of FBM's contents could be classified within six canonical categories (CCs), here we claim that assessing the presence of FBMs through guided CCs' questions - as done by most researchers in this field - can be misleading. We suggest, instead, to use free recall reports to identify the consistent perceptual elements of the snapshot. Across two test-retest studies, we show that the contents of FBMs assessed by free reports and the contents of CCs assessed by guided questions, do not exactly coincide. Moreover, a structural equation model supports results of previous research about the determinants of FBM and reveals that FBM facilitates the recall of more consistent explicitly requested CCs' contents. Theoretical implications concerning the qualitative contents of FBMs and the debate about their consistency are discussed.

Assessing measurement invariance of MSQOL-54 across Italian and English versions.

PURPOSE: The Multiple Sclerosis Quality of Life-54 (MSQOL-54) is a specific multiple sclerosis (MS) health-related quality of life inventory consisting of 52 items organized into 12 subscales plus two single items. No study was found in literature assessing its measurement invariance across language versions. We investigated whether MSQOL-54 items provide unbiased measurements of underlying constructs across Italian and English versions. METHODS: Three constrained levels of measurement invariance were evaluated: configural invariance where equivalent numbers of factors/factor patterns were required; metric invariance where equivalent factor loadings were required; and scalar invariance where equivalent item intercepts between groups were required. Comparative fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR) fit indices and their changes between nested models were used to assess tenability of invariance constraints. RESULTS: Overall, the dataset included 3669 MS patients: 1605 (44%) Italian, mean age 41 years, 62% women, 69% with mild level of disability; 2064 (56%) English-speaking (840 [41%] from North America, 797 [39%] from Australasia, 427 [20%] from UK and Ireland), mean age 46 years, 83% women, 54% with mild level of disability. The configural invariance model showed acceptable fit (RMSEA = 0.052, CFI = 0.904, SRMR = 0.046); imposing loadings and intercepts equality constraints produced negligible worsening of fit (ΔRMSEA < 0.001, ΔCFI = - 0.002, ΔSRMR = 0.002 for metric invariance; ΔRMSEA = 0.003, ΔCFI = - 0.013, ΔSRMR = 0.003 for scalar invariance). CONCLUSIONS: These findings support measurement invariance of the MSQOL-54 across the two language versions, suggesting that the questionnaire has the same meaning and the same measurement paramaters in the Italian and English versions.

Flexibility in Existential Beliefs and Worldview: Testing Measurement Invariance and Factorial Structure of the Existential Quest Scale in an Italian Sample of Adults.

The aim of the present study was to assess the psychometric properties of the Existential Quest (EQ) Scale, a nine-items instrument developed to assess openness to changing one's own convictions concerning existential issues. We developed the Italian version of the scale and examined factorial structure, internal consistency, discriminant validity, and measurement invariance across gender and age groups. A total of 291 Italian adults were recruited, and they completed a self-report questionnaire comprising measures of authoritarianism, cognitive closure, well-being, and religiousness, alongside the EQ. Confirmatory factor analysis showed that the original one-factor structure was replicated in this study, except for one-item that was removed from the subsequent analyses. Both the internal consistency of the eight-item scale as assessed by Cronbach's α and discriminant validity were in line with those of the original study. However, McDonald's reliability coefficient were quite low, and further researches employing repeated measures are needed in order to comprehend the contribution of the random error and that of the item specificity in lowering McDonald's coefficient. Finally, evidence of full measurement invariance across gender and partial measurement invariance across age was obtained. Overall, these findings suggest that the Italian version of the EQ is a promising tool for assessing flexibility about existential issues.

Empathy and Depression Among Early Adolescents: The Moderating Role of Parental Support.

Early adolescence is a period of development of emotional competence, but also of increasing vulnerability for the onset of depressive symptoms. While literature underscored that empathy promotes social relationships and psychological well-being over the life course, the possible role of high empathy levels as a risk factor for depression has been under investigated, especially among early adolescents. Moreover, although parenting practices are known to influence both empathy and depression in adolescence, few studies investigated if parenting moderates the relationship between empathy and depression. Therefore, the aims of the study were: (1) to investigate the relationships between affective and cognitive empathy and depression; (2) to investigate the moderating role of perceived paternal and maternal support on the associations between affective and cognitive empathy and depression; (3) to examine if the relationships among affective and cognitive empathy, maternal and paternal support and depression vary as a function of early adolescents' gender. The study involved 386 Italian students aged between 12 and 14 (M age = 13, SD = 0.3, 47.9% girls) who completed an anonymous self-report questionnaire, including measures of cognitive and affective empathy, paternal and maternal support and depression. Results showed that with a mean level of affective and cognitive empathy, higher maternal support was related to lower depression for girls, whereas higher paternal support was related to lower depression for both boys and girls. Both maternal and paternal support moderated the relation between empathy and depression. In particular, maternal support moderated the non-linear relation between affective empathy and depression and the relation was further moderated by early adolescents' gender: boys with low affective empathy reported lower depression in a context of high maternal support. Paternal support moderated the linear relation between cognitive empathy and depression, independently of early adolescents' gender: boys and girls with high cognitive empathy reported higher depression in a context of low paternal support. The results of the study suggested that high empathy might be a risk factor for depression during early adolescence and mothers and fathers have a differential moderating role in relation to the affective and cognitive dimensions of empathy, also in relation to early adolescents' gender.

The Fear of Pain Questionnaire: Factor structure, validity and reliability of the Italian translation.

BACKGROUND: The Fear of Pain Questionnaire-III (FPQ-III) is a self-report instrument developed to assess fear of different stimuli usually causing pain. The present study aimed to construct an Italian version of the FPQ-III and examine its psychometric properties in a heterogeneous sample of Italian healthy individuals. METHODS: The questionnaire was translated following the forward-backward method and completed by 511 Italian adults who met the inclusion criteria. Within 2 months of the first assessment, a subgroup of participants (n = 164) was re-tested. The factorial structure of the FPQ-III was assessed by confirmatory factor analysis (CFA). To better comprehend the FPQ-III's factorial structure, a CFA was also performed for each of the two reduced versions of the FPQ-III, namely the FPQ-Short Form and the FPQ-9. Divergent validity, test-retest reliability, and gender/age measurement invariance were also evaluated. RESULTS: The results of the CFA revealed that the original three-factor model poorly fitted the data, but it became satisfactory after allowing correlated error terms. Concerning divergent validity, correlations between FPQ-III scores and pain intensity, depression, and anxiety were found to be positive but weak in magnitude (< .20). FPQ-III subscales and total scores showed good internal consistency and time reliability. Finally, scalar invariance was only partially obtained, whereas all the other types of invariance were fully respected both for gender and age. CONCLUSIONS: The current findings indicate that the Italian version of the FPQ-III provides valid and reliable scores for the assessment of fear of pain in the Italian population.

eMSQOL-29: Prospective validation of the abbreviated, electronic version of MSQOL-54.

BACKGROUND: We recently devised a shortened version of the 54-item Multiple Sclerosis Quality of Life (MSQOL-54) in paper (MSQOL-29, consisting of 25 items forming 7 subscales and 4 single items, and one filter question for 3 'sexual function' items) and electronic format (eMSQOL-29). OBJECTIVES: To prospectively assess eMSQOL-29 psychometric properties, acceptability/equivalence versus MSQOL-29. METHODS: Multiple sclerosis (MS) patients ( n = 623; Expanded Disability Status Scale (EDSS) range 0.0-9.0) completed eMSQOL-29, Hospital Anxiety and Depression Scale, Functional Assessment of MS (FAMS), European Quality of life Five Dimensions-3L, and received EDSS and Symbol Digit Modalities Test (SDMT). Equivalence versus MSQOL-29 was assessed in 242 patients (randomized cross-over design). RESULTS: 'Sexual function' items were filtered out by 273 patients (47%). No multi-item scale had floor effect, while five had ceiling effect. Cronbach's alpha range was 0.88-0.90. Confirmatory factor analysis showed good overall fit and the two-factor solution for composite scores was confirmed. Criterion validity was sub-optimal for 'cognitive function' (vs SDMT, r = 0.25) and 'social function' (vs FAMS social function, r = 0.38). eMSQOL-29 equivalence was confirmed and its acceptability was good. CONCLUSION: eMSQOL-29 showed good internal consistency, factor structure and no floor effect, while most subscales had some ceiling effect. Criterion validity was sub-optimal for two subscales. Equivalence and acceptability were good.

Distractor Efficiency in an Item Pool for a Statistics Classroom Exam: Assessing Its Relation With Item Cognitive Level Classified According to Bloom's Taxonomy.

Multiple-choice items are one of the most commonly used tools for evaluating students' knowledge and skills. A key aspect of this type of assessment is the presence of functioning distractors, i.e., incorrect alternatives intended to be plausible for students with lower achievement. To our knowledge, no work has investigated the relationship between distractor performance and the complexity of the cognitive task required to give the correct answer. The aim of this study was to investigate this relation, employing the first three levels of Bloom's taxonomy (Knowledge, Comprehension, and Application). Specifically, it was hypothesized that items classified into a higher level of Bloom's classification would show a greater number of functioning distractors. The study involved 174 items administered to a sample of 848 undergraduate psychology students during their statistics exam. Each student received 30 items randomly selected from the 174-item pool. The bivariate results mainly supported the authors' hypothesis: the highest percentage of functioning distractors was observed among the items classified into the Application category (η2 = 0.024 and Phi = 0.25 for the dichotomized measure). When the analysis controlled for other item features, it lost statistical significance, partly because of the confounding effect of item difficulty.