Sexual Morbidity Assessment in Gyne-Oncology Follow-Up: Development of the Sexual Well-Being After Cervical or Endometrial Cancer (SWELL-CE) Patient-Reported Outcome Measure.

BACKGROUND: Clinical assessment and management of sexual difficulties after gynecological cancer remain a neglected aspect of women's rehabilitation. AIM: To develop and validate a patient-reported outcome measure of sexual well-being for women experiencing sexual consequences of cervical and endometrial cancer treatment for use in routine follow-up. METHODS: This is a sequential mixed method study comprising (i) in-depth qualitative interviews (n=21 of 118) to generate items regarding sexual consequences of cervical or endometrial cancer and treatment; (ii) questionnaire construction with 51 core items (all respondents) and 4 subsections (18-58 items), depending on the relationship status and whether or not participants were sexually active (SA/NSA); (iii) item refinement following cognitive debriefing (n=13 of 21); (iv) validation of resultant items via postal survey (n=788 women) and Rasch analysis; and (v) creation of brief (14-item) clinical screener. Women attending routine follow-up (3 months to 5 years) at 6 English cancer centers and members of 3 UK cancer patient websites, who met the study inclusion criteria, were invited to participate. OUTCOMES: The primary outcome of this study was the construction and initial psychometric testing of SWELL-CE short and long form versions. RESULTS: 21 women participated in interviews and 250 of 788 (32%) returned the postal survey (T1). 110 draft items were evaluated using cognitive testing (n=13) to refine instrument design and test face validity, comprehension, and acceptability. Exploratory factor analysis of survey data (n=250) produced an initial 6 domain structure as a guidance for the Rasch analysis. Subsequent Rasch analysis yielded a 3 domain structure: physical sexual function, sexual and relationship concerns, and sexual desire and sexual self-esteem, each satisfying Rasch model requirements within their respective SA (item pool =59) and NSA (item pool =53) categories, including the absence of local response dependency and all showing strict unidimensionality. The 3 subscales demonstrated good psychometric properties, external validity, and test-retest reliability. A valid Rasch short form of 14 items was created from the larger item pool. CLINICAL IMPLICATIONS: This PROM may assist clinicians to improve identification, discussion, and management of women who could benefit from sexual rehabilitation. STRENGTHS & LIMITATIONS: Initial evaluation supports psychometric validity and reliability in the assessment of physical sexual function, sexual interest and sexual self-esteem, and sexual and relationship concerns in this study sample. However, given this study's modest response rate (32%, n=250), findings should be interpreted with caution. This PROM identifies sexual concerns in women who are sexually active or sexually non-active due to illness or treatment-associated sexual difficulties. CONCLUSION: Sexual Well-being after Cervical or Endometrial Cancer is a novel and psychometrically valid sexual well-being measure for clinical assessment of female sexual difficulties after cervical or endometrial cancer treatment. White ID, Tennant A, Taylor C, Sexual Morbidity Assessment in Gyne-Oncology Follow-Up: Development of the Sexual Well-Being After Cervical or Endometrial Cancer (SWELL-CE) Patient-Reported Outcome Measure. J Sex Med 2020;17:2005-2015.

The influence and added value of a Standardized Assessment and Reporting System for functioning outcomes upon national rehabilitation quality reports.

OBJECTIVE: To demonstrate the influence and added value of a Standardized Assessment and Reporting System (StARS) upon the reporting of functioning outcomes for national rehabilitation quality reports. A StARS builds upon an ICF-based (International Classification of Functioning, Disability and Health) and interval-scaled common metric. DESIGN: Comparison of current ordinal-scaled Swiss national rehabilitation outcome reports including an expert-consensus-based transformation scale with StARS-based reports through descriptive statistical methods and content exploration of further development areas of the reports with relevant ICF Core Sets. SETTING: Swiss national public rehabilitation outcome quality reports on the clinic level. PARTICIPANTS: A total of 29 Swiss rehabilitation clinics provided their quality report datasets including 18 047 patients. INTERVENTIONS: Neurological or musculoskeletal rehabilitation. MAIN OUTCOME MEASURES: Functional Independence Measure™ or Extended Barthel Index. RESULTS: Outcomes reported with a StARS tended to be smaller but more precise than in the current ordinal-scaled reports, indicating an overestimation of achieved outcomes in the latter. The comparison of the common metric's content with ICF Core Sets suggests to include 'energy and drive functions' or 'maintaining a basic body position' to enhance the content of functioning as an indicator. CONCLUSIONS: A StARS supports the comparison of outcomes assessed with different measures on the same interval-scaled ICF-based common metric. Careful consideration is needed whether an ordinal-scaled or interval-scaled reporting system is applied as the magnitude and precision of reported outcomes is influenced. The StARS' ICF basis brings an added value by informing further development of functioning as a relevant indicator for national outcome quality reports in rehabilitation.

Integrating patient reported outcome measures and computerized adaptive test estimates on the same common metrics: an example from the assessment of activities in rheumatoid arthritis.

AIM: This study aimed to explore the potential of an inclusive and fully integrated measurement system for the Activities component of the International Classification of Functioning, Disability and Health (ICF), incorporating four classical scales, including the Health Assessment Questionnaire (HAQ), and a Computerized Adaptive Testing (CAT). METHODS: Three hundred patients with rheumatoid arthritis (RA) answered relevant questions from four questionnaires. Rasch analysis was performed to create an item bank using this item pool. A further 100 RA patients were recruited for a CAT application. Both real and simulated CATs were applied and the agreement between these CAT-based scores and 'paper-pencil' scores was evaluated with intraclass correlation coefficient (ICC). Anchoring strategies were used to obtain a direct translation from the item bank common metric to the HAQ score. RESULTS: Mean age of 300 patients was 52.3 ± 11.7 years; disease duration was 11.3 ± 8.0 years; 74.7% were women. After testing for the assumptions of Rasch analysis, a 28-item Activities item bank was created. The agreement between CAT-based scores and paper-pencil scores were high (ICC = 0.993). Using those HAQ items in the item bank as anchoring items, another Rasch analysis was performed with HAQ-8 scores as separate items together with anchoring items. Finally a conversion table of the item bank common metric to the HAQ scores was created. CONCLUSION: A fully integrated and inclusive health assessment system, illustrating the Activities component of the ICF, was built to assess RA patients. Raw score to metric conversions and vice versa were available, giving access to the metric by a simple look-up table.

Measurement properties of multidimensional patient-reported outcome measures in neurodisability: a systematic review of evaluation studies.

AIM: To identify and appraise the quality of studies that primarily assessed the measurement properties of English language versions of multidimensional patient-reported outcome measures (PROMs) when evaluated with children with neurodisability, and to summarize this evidence. METHOD: MEDLINE, Embase, PsycINFO, CINAHL, AMED, and the National Health Service Economic Evaluation Database were searched. The methodological quality of the papers was assessed using the COnsensus-based Standards for selection of health Measurement INstruments checklist. Evidence of content validity, construct validity, internal consistency, test-retest reliability, proxy reliability, responsiveness, and precision was extracted and judged against standardized reference criteria. RESULTS: We identified 48 studies of mostly fair to good methodological quality: 37 papers for seven generic PROMs (CHIP, CHQ, CQoL, KIDSCREEN, PedsQL, SLSS, and YQOL), seven papers for two chronic-generic PROMs (DISABKIDS and Neuro-QOL), and four papers for three preference-based measures (HUI, EQ-5D-Y, and CHSCS-PS). INTERPRETATION: On the basis of this appraisal, the DISABKIDS appears to have more supportive evidence in samples of children with neurodisability. The overall lack of evidence for responsiveness and measurement error is a concern when using these instruments to measure change, or to interpret the findings of studies in which these PROMs have been used to assess change.

Meaningful health outcomes for paediatric neurodisability: Stakeholder prioritisation and appropriateness of patient reported outcome measures.

BACKGROUND: Health services are increasingly focused on measuring and monitoring outcomes, particularly those that reflect patients' priorities. To be meaningful, outcomes measured should be valued by patients and carers, be consistent with what health professionals seek to achieve, and be robust in terms of measurement properties. The aim of this study was (i) to seek a shared vision between families and clinicians regarding key aspects of health as outcomes, beyond mortality and morbidity, for children with neurodisability, and (ii) to appraise which multidimensional patient reported outcome measures (PROMs) could be used to assess salient health domains. METHODS: Relevant outcomes were identified from (i) qualitative research with children and young people with neurodisability and parent carers, (ii) Delphi survey with health professionals, and (iii) systematic review of PROMs. The International Classification of Functioning Disability and Health provided a common language to code aspects of health. A subset of stakeholders participated in a prioritisation meeting incorporating a Q-sorting task to discuss and rank aspects of health. RESULTS: A total of 33 pertinent aspects of health were identified. Fifteen stakeholders from the qualitative and Delphi studies participated in the prioritisation meeting: 3 young people, 5 parent carers, and 7 health professionals. Aspects of health that emerged as more important for families and targets for health professionals were: communication, emotional wellbeing, pain, sleep, mobility, self-care, independence, mental health, community and social life, behaviour, toileting and safety. Whilst available PROMs measure many aspects of health in the ICF, no single PROM captures all the key domains prioritised as for children and young people with neurodisability. The paucity of scales for assessing communication was notable. CONCLUSIONS: We propose a core suite of key outcome domains for children with neurodisability that could be used in evaluative research, audit and as health service performance indicators. Future work could appraise domain-specific PROMs for these aspects of health; a single measure assessing the key aspects of health that could be applied across paediatric neurodisability remains to be developed.

Assessing the risk of self-harm in an adult offender population: an incidence cohort study.

BACKGROUND: Self-harm is common among prisoners, particularly female prisoners. In 2007, concerned about the rising incidence, the prison service introduced a care-planning system called Assessment, Care in Custody, and Teamwork (ACCT). To date, it does not incorporate a standardised diagnostic test to estimate the risk of future self-harm. OBJECTIVE: To identify potential screening instruments, or items from those instruments, to predict the risk of self-harm among prisoners. PARTICIPANTS: Prisoners who had been assigned to an ACCT during the recruitment period. DESIGN: A multistage prospective cohort study. Following a pilot study, instruments were administered to prisoners by interview at baseline, and followed up for 6 months (or until point of release if this was sooner) to ascertain self-harm status. Instruments were assessed for unidimensionality, scalability (Mokken) and quantitative structure (Rasch). Area under the curve (AUC) analysis was used to examine the ability of instruments and/or their items to predict future self-harm. Cox proportional hazards regression models were used to examine the multivariate predictive ability of the scales and various sociodemographic and sentencing factors. SETTING: Three prisons (including one women's prison) in northern England. MAIN OUTCOME MEASURES: A set of standardised questionnaires, including the Prison Screening Questionnaire (PriSnQuest), Revised Borderline Symptom List-23 (frequency-based responses) (BSL-23-F), Self-Harm Inventory (SHI), Patient Health Questionnaire (PHQ-9) and the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), together with sociodemographic and sentencing data. RESULTS: In total, 450 prisoners consented to participate in the study, of whom 26% were female. The mean age of participants was 31.2 years. Over half of male prisoners recruited were on remand, compared with just over one-fifth (22.6%) of female prisoners. The average tariff of those sentenced was 41 months, of which 14.7 months, on average, had been served. Just over one-third of ACCTs had been initiated because of a known self-harm event, and over one-quarter (27.8%) of participants self-harmed during the follow-up period. Thus, almost half (46.7%) of those entered into the study were reported to have self-harmed, either from their index ACCT, or subsequently, or both. Cutting was the most frequent behaviour (51%). All screening instruments showed some evidence of unidimensionality, and four out of five showed scaling criteria consistent with ordinal scaling, so verifying the validity of the cut points. However, many showed gender bias and failure to fit the Rasch measurement model. While a resolution was made in most cases, both ordinal raw scores and latent interval scale estimates failed to show predictive value when applied within AUC analysis (0.491-0.566) or adjusted Cox proportional hazards models. However, good predictive values were shown for gender-specific sets of items, thus providing easily applied screening indexes. CONCLUSIONS: While four out of five potential screening instruments were found to have acceptable psychometric properties within this setting, their predictive validity of all instruments was poor under AUC analysis. Gender-specific item sets were put together to form two screening indexes with formative indicators which gave reasonable AUC values, particularly so for females. The indexes provide identification of low-medium-high risk of self-harm, and so may help to inform potential care pathways and decisions to sign prisoners off from the ACCT. Future work should concentrate on refining a set of predictive screening items among different offender populations and investigating the time point at which this set of items should be administered. Future work may also look at the different magnitudes of risk as indicators for care pathways. FUNDING: The National Institute for Health Research Health Technology Assessment programme.

Validation of the educational needs assessment tool as a generic instrument for rheumatic diseases in seven European countries.

OBJECTIVES: To validate the educational needs assessment tool (ENAT) as a generic tool for assessing the educational needs of patients with rheumatic diseases in European Countries. METHODS: A convenience sample of patients from seven European countries was included comprising the following diagnostic groups: ankylosing spondylitis, psoriatic arthritis, systemic sclerosis, systemic lupus erythematosus, osteoarthritis (OA) and fibromyalgia syndrome. Translated versions of the ENAT were completed through surveys in each country. Rasch analysis was used to assess the construct validity of the adapted ENATs including differential item functioning by culture (cross-cultural DIF). Initially, the data from each country and diagnostic group were fitted to the Rasch model separately, and then the pooled data from each diagnostic group. RESULTS: The sample comprised 3015 patients; the majority, 1996 (66.2%), were women. Patient characteristics (stratified by diagnostic group) were comparable across countries except the educational background, which was variable. In most occasions, the 39-item ENAT deviated significantly from the Rasch model expectations (item-trait interaction χ(2) p<0.05). After correction for local dependency (grouping the items into seven domains and analysing them as 'testlets'), fit to the model was satisfied (item-trait interaction χ(2) p>0.18) in all pooled disease group datasets except OA (χ(2)=99.91; p=0.002). The internal consistency in each group was high (Person Separation Index above 0.90). There was no significant DIF by person characteristics. Cross-cultural DIF was found in some items, which required adjustments. Subsequently, interval-level scales were calibrated to enable transformation of ENAT scores when required. CONCLUSIONS: The adapted ENAT is a valid tool with high internal consistency providing accurate estimation of the educational needs of people with rheumatic diseases. Cross-cultural comparison of educational needs is now possible.

Adaptive screening for depression--recalibration of an item bank for the assessment of depression in persons with mental and somatic diseases and evaluation in a simulated computer-adaptive test environment.

OBJECTIVE: This study conducted a simulation study for computer-adaptive testing based on the Aachen Depression Item Bank (ADIB), which was developed for the assessment of depression in persons with somatic diseases. Prior to computer-adaptive test simulation, the ADIB was newly calibrated. METHODS: Recalibration was performed in a sample of 161 patients treated for a depressive syndrome, 103 patients from cardiology, and 103 patients from otorhinolaryngology (mean age 44.1, SD=14.0; 44.7% female) and was cross-validated in a sample of 117 patients undergoing rehabilitation for cardiac diseases (mean age 58.4, SD=10.5; 24.8% women). Unidimensionality of the itembank was checked and a Rasch analysis was performed that evaluated local dependency (LD), differential item functioning (DIF), item fit and reliability. CAT-simulation was conducted with the total sample and additional simulated data. RESULTS: Recalibration resulted in a strictly unidimensional item bank with 36 items, showing good Rasch model fit (item fit residuals<|2.5|) and no DIF or LD. CAT simulation revealed that 13 items on average were necessary to estimate depression in the range of -2 and +2 logits when terminating at SE≤0.32 and 4 items if using SE≤0.50. Receiver Operating Characteristics analysis showed that θ estimates based on the CAT algorithm have good criterion validity with regard to depression diagnoses (Area Under the Curve≥.78 for all cut-off criteria). CONCLUSION: The recalibration of the ADIB succeeded and the simulation studies conducted suggest that it has good screening performance in the samples investigated and that it may reasonably add to the improvement of depression assessment.

The reliability and validity of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke.

PURPOSE: Psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke have received some attention recently, mostly using classical approaches, but there is still an absence of investigation from a modern psychometric perspective. This study aimed to test the reliability and validity of the WHODAS-II in stroke, using modern psychometric analysis. METHODS: A total of 188 community-dwelling poststroke patients were recruited. Internal construct validity was assessed by Rasch analysis, reliability by internal consistency and person separation index (PSI), and external construct validity by associations with Functional Independence Measure (FIM(™)). RESULTS: Rasch analysis indicated that total score (based upon 32 items, omitting the work-related items) was satisfactory, after adjustment for local dependency. The proposed "activities" and "participation" components also satisfied Rasch model expectations. An existing short form was problematic due to inclusion of a work-related item, but an alternative 10-item version was acceptable. Cronbach's α for the WHODAS-II, its domains and components varied between 0.83 and 0.99 and PSI between 0.70 and 0.95. External construct validity was confirmed by expected correlations with FIM(™). CONCLUSIONS: WHODAS-II provides a reliable and valid instrument for measuring disability and components of "activities" and "participation" in stroke survivors. Various combinations of the item set may provide a range of scales to suit most research needs.

Strategies for assessment and outcome measurement in physical and rehabilitation medicine: an educational review.

The aim of this educational review, which is based upon expert opinion, is to describe to clinicians training in Physical and Rehabilitation Medicine and research students training to work in the field, the appropriate attributes and standards required for assessment and outcome measurement. "What to assess" is discussed in the context of the conceptual framework provided by the International Classification of Functioning, Disability and Health, supplemented with quality of life as an additional construct. The reasons for making the assessment, and the context in which the assessment will be used, are then considered. Examples of recommendations of some international organizations regarding what and how to assess are presented. Suggestions are made about the selection of assessment tools, including examples from two diagnostic groups: stroke and rheumatoid arthritis. Finally, the basic psychometric standards required for any assessment tool, and additional requirements for outcome assessment, are explained.

Cross-cultural validation of the Educational Needs Assessment Tool in RA in 7 European countries.

BACKGROUND: The Educational Needs Assessment Tool (the ENAT) is a 39-item patient questionnaire originally developed in the UK to assess educational needs of patients with rheumatoid arthritis (RA). The objective of this study was to assess the cross-cultural validity of the ENAT in 7 European countries. METHODS: The ENAT was translated into Dutch, Finnish, Norwegian, Portuguese, Spanish and Swedish versions by using Beaton's cross-cultural adaptation process, and was completed by a convenience sample of patients with RA in each country. The generated country-specific data were assessed for construct validity and were then pooled and assessed for cross-cultural invariance using Rasch analysis. RESULTS: Individual country-specific analysis showed adequate fit to the Rasch model after adjustment for local dependency within domains. When data from the different countries were pooled, the 39 items deviated significantly from Rasch model's expectations (X(2)=977.055, DF=351, p=0.000, PSI=0.976). Again, most items within domains were found to be locally dependent, significantly affecting the fit. Consequently each domain was treated as a unit (i.e. testlet) and the ENAT was re-analysed as a seven-testlet scale resulting into a good fit to the Rasch model (X(2)=71.909; DF=63; p=0.207, PSI=0.951). A test of strict unidimensionality confirmed that all domains contributed to measuring a single construct. Cross-cultural non-invariance was discounted by splitting domains for DIF maintaining an excellent fit to the Rasch model. This allowed calibration of the ENAT into an interval scale. CONCLUSION: The ENAT is a simple tool, which is a valid measure of educational needs of people with RA. Adjustment for cross-cultural non-invariance is available if data from the 7 European countries are to be pooled or compared.

Validation of the World Health Organization disability assessment schedule II (WHODAS-II) in patients with osteoarthritis.

The objective of this study is to test the reliability and validity of WHODAS-II (Turkish version) for the assessment of disability in patients with osteoarthritis. This study is designed as follows: the internal construct validity of WHODAS-II in patients with knee osteoarthritis was assessed by Rasch analysis, and external construct validity by association with the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) and the Nottingham Health Profile (NHP); reliability was tested by internal consistency, intra-class correlation coefficient (ICC) and test-retest ICC. Our study presents the results of 225 outpatients assessed with mean age 58.4 years (SD 11.1) of whom 80.9% were female. Cronbach's α, ICC, and test-retest ICC values for the six subscales of WHODAS-II varied between 0.71 and 0.94, 0.71 and 0.94, and 0.87 and 0.97, respectively. Rasch analysis of WHODAS-II indicated that after adjustment for local dependency, satisfactory fit was achieved. Two separate 'activities' and 'participation' components could also be identified. External construct validity of the scale was confirmed with expected correlations with WOMAC and NHP. This study concludes that WHODAS-II provides a reliable and valid health status instrument for measuring disability and components of 'activities' and 'participation' in patients with osteoarthritis. Thus, it provides the opportunity to model the consequences of disease according to the International Classification of Functioning, Disability and Health framework.

Factor analysis and Rasch analysis of the Zarit Burden Interview for acquired brain injury carer research.

OBJECTIVE: To examine the dimensionality of the Zarit Burden Interview in a sample of carers of adults with acquired brain injury. DESIGN: A cross-sectional UK survey using postal questionnaires. PARTICIPANTS: A sample of 222 carers; 43 men (19.4%) and 179 women (80.6%); mean age 54 years. Types of brain injury included traumatic brain injury (49.5%), stroke (25.9%), brain infection (17.3%), hypoxia (4.1%), and "other" (3.2%). METHODS: Exploratory and confirmatory factor analysis and Rasch analysis. RESULTS: Unidimensionality was tested using confirmatory factor analysis, which showed a poor fit. The underlying structure of the Zarit Burden Interview was explored using principal components analysis and varimax rotation. This revealed 3 factors, although 1 comprised only 2 items. The 2 major factors identified were personal strain and role strain. They were then examined using Rasch analysis, which identified 2 brief and reliable unidimensional scales. There was no evidence of differential item functioning for different types of carer/brain injury. CONCLUSION: The Zarit Burden Interview is a promising mea-sure for the assessment of burden in carers of people with an acquired brain injury. It offers 2 reliable, brief subscales of personal strain and role strain for this purpose. However, it remains for these 2 brief subscales to be validated clinically in future research.

Psychometric properties of the Rivermead Motor Assessment: its utility in stroke.

OBJECTIVE: To investigate the psychometric properties of the Rivermead Motor Assessment by Rasch analysis and conventional statistics to improve its clinical utility. METHODS: A total of 107 patients after stroke were evaluated using the Rivermead Motor Assessment and Functional Independence Measure (FIM). Scaling properties were assessed using Mokken scaling, internal construct validity using Rasch analysis, reliability using Cronbach's alpha and intra-class correlation coefficients, external construct validity through convergent validity with FIM, and responsiveness using the effect size and standardized response mean. RESULTS: Cronbach's alpha and intra-class correlation coefficients for 3 sections of the Rivermead Motor Assessment were between 0.88 and 0.95. Mokken scaling showed appropriate Guttman patterns, but the hierarchical ordering of the items differed from that of the original. After removing 4 items of gross function, 1 of leg-trunk, and 4 of arm, all sections met Rasch model expectations. External construct validity was confirmed. Mean values of effect size and standardized response were 0.38-0.51 and 0.60-0.89, respectively. CONCLUSION: The Rivermead Motor Assessment has been shown to be reliable and responsive. Guttman scaling is apparent, but not as originally defined. After removing some items, the scale satisfies the most stringent Rasch measurement criteria and can produce interval scaling for the assessment of motor function in stroke.

Psychometric properties of the WeeFIM in children with cerebral palsy in Turkey.

The Functional Independence Measure for Children (WeeFIM) instrument has recently been adapted and validated for non-disabled children in Turkey. The aim of this study was to validate the instrument in children with cerebral palsy (CP). One hundred and thirty-four children with CP were assessed using the WeeFIM. Reliability was tested by internal consistency, intraclass and interrater correlation coefficients (ICCs), internal construct validity by Rasch analysis, and external construct validity by correlation with the Denver II Development Test (Denver II). Mean age of the participants (70 females, 64 males) was 4y 6mo (SD 3y 8mo, range 6mo-16y). CP type was: diplegia in 37.3%, hemiplegia in 20.2%, quadriplegia in 8.2%, 'baby at risk' (i.e. infants who show neuromotor delay but cannot be classified in a CP type) in 29.9%, and other in 4.5%. Reliability of the WeeFIM was excellent with high Cronbach's alpha and ICC values ranging between 0.91 and 0.98 for the motor and cognitive scales. After collapsing response categories, both motor and cognitive scales met Rasch model expectations. Unidimensionality of the motor scale was confirmed after adjustment for local dependency of items. There was no substantive differential item functioning and strict unidimensionality for both scales was shown by analysis of the residuals. External construct validity was supported by expected high correlations with developmental ages determined by the social, fine motor function, language, and gross motor function domains of the Denver II. We conclude that the WeeFIM is a reliable and valid instrument for evaluating the functional status of Turkish children with CP.

The development and validation of the Office Work Screen.

BACKGROUND: The prevalence and costs to both employers and individuals of musculoskeletal disorders and associated psychosocial factors are well documented. There is increasing evidence that early identification is the key to the prevention of chronicity and sickness absence. AIMS: The study aimed to develop and validate a screening questionnaire, capturing relevant psychosocial issues and musculoskeletal symptoms, to measure work instability (WI) in office workers. METHODS: The staged methodology was based upon Rasch analysis and included item banking from existing Work Instability scales and analysis of new data from postal surveys. The criterion validity of the emerging scale was examined using vocational assessments by occupational physiotherapists. RESULTS: A 62-item questionnaire was returned by 153 employees from two different settings. The data were fitted to the Rasch model and 26 items were found to fit model expectations (chi-square P= 0.07), satisfy strict requirements for unidimensionality and discriminate across expert defined levels of WI. Reliability was 0.9, indicating suitability for use at the individual level. Absence of item bias was shown for age, gender and if the individual had been off sick from work in the past 3 months, suggesting the scale is robust to variations in workforce composition and sickness absence rates. CONCLUSIONS: The Office Work Screen is a short questionnaire incorporating both musculoskeletal symptoms and relevant psychosocial factors in one dimension. This new questionnaire may facilitate workforce screening, individual monitoring and proactive targeting of interventions (for example, vocational rehabilitation) to prevent or minimize sickness absence in office workers.

Validation of the Middlesex Elderly Assessment of Mental State (MEAMS) as a cognitive screening test in patients with acquired brain injury in Turkey.

PURPOSE: Assessment of cognitive impairment with a valid cognitive screening tool is essential in neurorehabilitation. The aim of this study was to test the reliability and validity of the Turkish-adapted version of the Middlesex Elderly Assessment of Mental State (MEAMS) among acquired brain injury patients in Turkey. METHODS: Some 155 patients with acquired brain injury admitted for rehabilitation were assessed by the adapted version of MEAMS at admission and discharge. Reliability was tested by internal consistency, intra-class correlation coefficient (ICC) and person separation index; internal construct validity by Rasch analysis; external construct validity by associations with physical and cognitive disability (FIM); and responsiveness by Effect Size. RESULTS: Reliability was found to be good with Cronbach's alpha of 0.82 at both admission and discharge; and likewise an ICC of 0.80. Person separation index was 0.813. Internal construct validity was good by fit of the data to the Rasch model (mean item fit -0.178; SD 1.019). Items were substantially free of differential item functioning. External construct validity was confirmed by expected associations with physical and cognitive disability. Effect size was 0.42 compared with 0.22 for cognitive FIM. CONCLUSION: The reliability and validity of the Turkish version of MEAMS as a cognitive impairment screening tool in acquired brain injury has been demonstrated.

Assessing normative cut points through differential item functioning analysis: an example from the adaptation of the Middlesex Elderly Assessment of Mental State (MEAMS) for use as a cognitive screening test in Turkey.

BACKGROUND: The Middlesex Elderly Assessment of Mental State (MEAMS) was developed as a screening test to detect cognitive impairment in the elderly. It includes 12 subtests, each having a 'pass score'. A series of tasks were undertaken to adapt the measure for use in the adult population in Turkey and to determine the validity of existing cut points for passing subtests, given the wide range of educational level in the Turkish population. This study focuses on identifying and validating the scoring system of the MEAMS for Turkish adult population. METHODS: After the translation procedure, 350 normal subjects and 158 acquired brain injury patients were assessed by the Turkish version of MEAMS. Initially, appropriate pass scores for the normal population were determined through ANOVA post-hoc tests according to age, gender and education. Rasch analysis was then used to test the internal construct validity of the scale and the validity of the cut points for pass scores on the pooled data by using Differential Item Functioning (DIF) analysis within the framework of the Rasch model. RESULTS: Data with the initially modified pass scores were analyzed. DIF was found for certain subtests by age and education, but not for gender. Following this, pass scores were further adjusted and data re-fitted to the model. All subtests were found to fit the Rasch model (mean item fit 0.184, SD 0.319; person fit -0.224, SD 0.557) and DIF was then found to be absent. Thus the final pass scores for all subtests were determined. CONCLUSION: The MEAMS offers a valid assessment of cognitive state for the adult Turkish population, and the revised cut points accommodate for age and education. Further studies are required to ascertain the validity in different diagnostic groups.

Identifying patients at risk of nursing home admission: The Leeds Elderly Assessment Dependency Screening tool (LEADS).

BACKGROUND: Discharge from hospital to a nursing home represents a major event in the life of an older person and should only follow a comprehensive functional and medical assessment. A previous study identified 3 dependency scales able to discriminate across outcomes for older people admitted to an acute setting. We wished to determine if a single dependency scale derived from the 3 scales could be created. In addition could this new scale with other predictors be used as a comprehensive tool to identify patients at risk of nursing home admission. METHODS: Items from the 3 scales were combined and analysed using Rasch Analysis. Sensitivity and specificity analysis and ROC curves were applied to identify the most appropriate cut score. Binary logistic regression using this cut-off, and other predictive variables, were used to create a predictive algorithm score. Sensitivity, specificity and likelihood ratio scores of the algorithm scores were used to identify the best predictive score for risk of nursing home placement. RESULTS: A 17-item (LEADS) scale was derived, which together with four other indicators, had a sensitivity of 88% for patients at risk of nursing home placement, and a specificity of 85% for not needing a nursing home placement, within 2 weeks of admission. CONCLUSION: A combined short 17-item scale of dependency plus other predictive variables can assess the risk of nursing home placement for older people in an acute care setting within 2 weeks of admission. This gives an opportunity for either early discharge planning, or therapeutic intervention to offset the risk of placement.

Admission to hospital following head injury in England: incidence and socio-economic associations.

BACKGROUND: Head injury in England is common. Evidence suggests that socio-economic factors may cause variation in incidence, and this variation may affect planning for services to meet the needs of those who have sustained a head injury. METHODS: Socio-economic data were obtained from the UK Office for National Statistics and merged with Hospital Episodes Statistics obtained from the Department of Health. All patients admitted for head injury with ICD-10 codes S00.0-S09.9 during 2001-2 and 2002-3 were included and collated at the level of the extant Health Authorities (HA) for 2002, and Primary Care Trust (PCT) for 2003. Incidence was determined, and cluster analysis and multiple regression analysis were used to look at patterns and associations. RESULTS: 112,718 patients were admitted during 2001-2 giving a hospitalised incidence rate for England of 229 per 100,000. This rate varied across the English HA's ranging from 91-419 per 100,000. The rate remained unchanged for 2002-3 with a similar magnitude of variation across PCT's. Three clusters of HA's were identified from the 2001-2 data; those typical of London, those of the Shire counties, and those of Other Urban authorities. Socio-economic factors were found to account for a high proportion of the variance in incidence for 2001-2. The same pattern emerged for 2002-3 at the PCT level. The use of public transport for travel to work is associated with a decreased incidence and lifestyle indicators, such as the numbers of young unemployed, increase the incidence. CONCLUSION: Head injury incidence in England varies by a factor of 4.6 across HA's and PCT's. Planning head injury related services at the local level thus needs to be based on local incidence figures rather than regional or national estimates. Socio-economic factors are shown to be associated with admission, including travel to work patterns and lifestyle indicators, which suggests that incidence is amenable to policy initiatives at the macro level as well as preventive programmes targeted at key groups.