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

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

Item-Level Psychometrics of the Neonatal Eating Outcome Assessment in Orally Feeding Infants.

BACKGROUND: The Neonatal Eating Outcome Assessment determines feeding performance based on the infant's postmenstrual age (PMA). OBJECTIVE: To examine item-level measurement properties of this assessment's rating scale. METHODOLOGY: In this retrospective study, Rasch analysis was completed on clinical data from the Neonatal Eating Outcome Assessment for 100 infants (52 preterm and 48 full-term) using Winsteps version 3.93.1. Instead of PMA-based scores, ordered letters converted to numerical scores were analyzed. RESULTS: Analysis demonstrated that Section I (Pre-Feeding Skills) represents a separate construct from Sections II and III (Oral Feeding and End of Feeding, respectively). Sections II and III were adequately unidimensional to complete Rasch analysis. These sections fit the Rasch model overall, but rating scale category underuse was common, which may be attributed to sample characteristics. IMPLICATIONS: This analysis supports using validated ordered letter scoring of Sections II and III to measure oral feeding performance in preterm and full-term newborns.

Examining Measurement Properties of Items in the Neonatal Eating Outcome AssessmentThe Neonatal Eating Outcome Assessment is used to evaluate infant feeding skills, considering expected performance based on the infant's age. We completed Rasch analysis of this assessment using data from 100 infants (52 preterm and 48 full-term). Analysis used ordered letter scores (not based on infant age) which allowed comparison of the skill level of each infant and the difficulty level of each assessment item. This also provided information about how well each item measures the feeding behavior it intends to assess. Study limitations included underutilization of some rating scale categories and inability to analyze Section I. However, overall, results showed that items in Sections II and III of The Neonatal Eating Outcome Assessment provide good measurement of infants' oral feeding performance. This information will help clinicians and researchers understand this assessment's strengths and opportunities for improvement.

Conditional Minimal Detectable Change for the Cochlear Implant Quality of Life-35 Profile Associated With Improved Functional Abilities 12 Months After Cochlear Implantation.

Importance: It is essential to measure an individual patient's baseline and follow-up abilities to demonstrate changes in clinical outcomes over time. Inherent in this strategy is interpreting whether the measured change is clinically significant and beyond measurement error. Conditional minimal detectable change (cMDC) values are widely used in many disciplines but have rarely been established for outcome measures in otolaryngology or hearing research, and never in cochlear implantation. Objective: To determine cMDC values for the Cochlear Implant Quality of Life-35 (CIQOL-35) Profile instrument to enhance our understanding of the initial and ongoing changes in functional abilities from cochlear implants (CIs). Design, Setting, and Participants: Item response theory analyses of responses from a multi-institutional cohort of 705 CI users at a tertiary CI center were used to derive standard error (SE) values for each possible CIQOL-35 domain score. Using an iterative approach, these SE values were used to calculate cMDC values for every possible pre-CI and post-CI domain score combination. We then compared pre-CI to 12-month post-CI CIQOL-35 domains scores in an independent cohort of 65 adult CI users to determine whether the measured change exceeded error to be clinically significant. The analysis took place on December 14, 2022. Interventions: The CIQOL-35 Profile instrument and cochlear implantation. Results: The cMDC values were smaller for the communication domain, and global measure and cMDC values for all domains were larger at the extremes of the measurement scale. Overall, 60 CI users (92.3%) demonstrated improvement beyond cMDC at 12 months post-CI for at least 1 CIQOL-35 domain, and no patients' scores declined beyond cMDC for any domain. The percentage of CI users demonstrating improvement beyond cMDC varied by domain, with communication (53 [81.5%]) showing the largest number of CI users improving, followed by global (42 [64.6%]) and entertainment (40 [60.9%]). In general, CI users who demonstrated improvement in CIQOL-35 domains had greater improvement in speech recognition scores than patients who did not, but the strength and significance of these associations greatly varied by domain and speech material. Conclusions and Relevance: This multistep cohort study found that cMDC values for the CIQOL-35 Profile provided personalized thresholds for detecting real changes in patient self-reported functional abilities over time across multiple domains, which may inform clinical decision-making. Moreover, these longitudinal results reveal the domains with more or less improvement, which may aid in patient counseling.

The Functional Balance Ability Measure: A Measure of Balance Across the Spectrum of Functional Mobility in Persons Post-Stroke.

Objective: To determine whether the measurement properties of an instrument that combines items from the Berg Balance Scale (BBS) and the Functional Gait Assessment (FGA) called the Functional Balance Ability Measure (FBAM) supports measuring balance across the functional mobility spectrum. Design: Retrospective cohort. Setting: Item-level data were from an archival research database. Participants: Ambulatory individuals (N=93, BBS=50 [29-56], FGA=16 [0-30], Fugl-Meyer Assessment of Lower Extremities=27 [14-34], self-selected walking speed=0.4±0.2 m/s, mean age ± SD, 61.7±11.3y; 30.1% female) with chronic stroke (≥6 months). Interventions: Not applicable. Main Outcome Measures: Unidimensionality was evaluated with a principal components analysis (PCA) of residuals. FBAM rating-scale characteristics, item hierarchy, item and person fit, and person separation were investigated using the Andrich Rating Scale Model. Results: PCA findings indicate the FBAM is sufficiently unidimensional. Rating scale structure was appropriate without modifying the original BBS and FGA scoring systems. Item hierarchy aligned with clinical and theoretical predictions (hardest item: FGA-gait with narrow base of support, easiest item: BBS-sitting unsupported). One item (BBS-standing on 1 foot) misfit, however, removal marginally affected person measures and model statistics. The FBAM demonstrated high person reliability (0.9) and 6 people (∼6%) misfit the expected response pattern. The FBAM separated participants into 4 statistically distinct strata, without a floor or ceiling effect. Conclusions: The FBAM is a unidimensional measure for balance ability across a continuum of functional tasks. Rating-scale characteristics, item hierarchy, item and person fit, and person separation support the FBAM's measurement properties in persons with chronic stroke. Future work should investigate measurement with fewer items and whether the FBAM addresses barriers to adoption of standardized balance measures in clinical practice.

Development and Implementation of the Cochlear Implant Quality of Life (CIQOL) Functional Staging System.

OBJECTIVES: The purpose of this study is to develop and implement a functional staging system using the Cochlear Implant Quality of Life (CIQOL) framework. The CIQOL-35 Profile was developed and validated following a rigorous research design and found to be more comprehensive and psychometrically sound than previous patient-reported outcome measures (PROMs) applied to adult CI users. However, interpreting the CIQOL-35 Profile (and all PROMs) relative to real-world functioning remains difficult for patients and clinicians, which limits the capacity of PROMs to direct clinical care. To address this limitation, a functional staging system based on PROM scores was developed to provide detailed descriptions of patients' self-reported abilities (clinical vignettes) without sacrificing the inherent value of the psychometrically derived scores. The current study (1) creates an evidence-based CIQOL functional staging system using advanced psychometric techniques, (2) confirms the clarity and meaningfulness of the staging system with patients, and (3) implements the staging system to measure CIQOL stage progression using data from a longitudinal study design. METHODS: Item response theory (IRT) analyses of CIQOL-35 Profile data from 705 experienced adult CI users and expert opinion were used to determine the cut-scores that separated adjacent stages for the six CIQOL-35 domains (communication, emotional, entertainment, environment, listening effort, and social). The research team then created clinical vignettes based on item response patterns for each stage. Semi-structured key informant interviews were conducted with 10 adult CI users to determine the clarity and meaningfulness of the CIQOL stages and associated clinical vignettes. Finally, we prospectively collected CIQOL-35 Profile scores from 42 CI users prior to cochlear implantation and then at 3- and 6-months post-CI activation to measure CIQOL stage progression. RESULTS: Psychometric analyses identified five statistically distinct stages for the communication domain and three stages for all other domains. Using IRT analysis results for guidance, research team members independently identified the cut-scores that represented transitions between the functional stages for each domain with excellent agreement (κ = 0.98 [95% confidence interval 0.96-0.99]). Next, the key informant interviews revealed that CI users found the clinical vignettes to be clear and only minor changes were required. Participants also agreed that stage progression represented meaningful improvements in functional abilities. Finally, 88.1% of 42 patients in the prospective cohort (n = 37) improved from pre-CI functional stage by at least one functional stage in one or more domains. The communication domain had the greatest number of patients improve by one or more stages (59.5%) and the social domain the fewest (25.6%). There was also a trend for less improvement at 3- and 6-months post-CI activation for patients at higher pre-CI functional stages, even though higher stages were achievable. CONCLUSION: The new CIQOL functional staging system provides an evidence-based understanding of the real-world functional abilities of adult CI users from pre-CI to 3- to 6-months post-CI activation across multiple domains. In addition, study results provide the proportion of CI users in each stage at each timepoint. Results can be used during discussions of expectations with potential CI users to provide enhanced insight regarding realistic outcomes and the anticipated timing for improvements. The use of the CIQOL functional staging system also presents an opportunity to develop individualized goal-based rehabilitation strategies that target barriers to stage advancement faced by CI users. LEVEL OF EVIDENCE: 2 Laryngoscope, 132:S1-S13, 2022.

Normative Cochlear Implant Quality of Life (CIQOL)-35 Profile and CIQOL-10 Global Scores for Experienced Cochlear Implant Users from a Multi-Institutional Study.

OBJECTIVE: Although adult cochlear implant (CI) outcomes have primarily focused on speech recognition scores, the rigorous development of a CI-specific patient-reported outcome measure provides an opportunity for a more comprehensive and ecologically valid approach to measure the real-world functional abilities of adult CI users. Here, we report for the first time normative Cochlear Implant Quality of Life (CIQOL)-35 Profile and global scores and variance for a large, multi-institutional sample of adult CI users. STUDY DESIGN: Cross-sectional study design. SETTING: CI centers in the United States. PATIENTS: Seven hundred five adults with bilateral moderate to profound hearing loss with at least 1 year of CI use. INTERVENTIONS: Cochlear implantation. MAIN OUTCOME MEASURES: CIQOL-35 Profile and CIQOL-10 Global scores. RESULTS: During the development of the CIQOL instruments, 1,000 CI users from all regions of the United States were invited to participate in studies. Of these, 705 (70.5%) completed all portions of the study, and their data are reported here. Mean CIQOL domain scores were highest (indicating better function) for the emotional and social domains and lowest for listening effort. The entertainment and social domains demonstrated the widest distribution of scores and largest standard deviations, indicating greatest variability in function. Overall, there were minimal ceiling and floor effects for all domains. CONCLUSION: Normative scores from a large sample of experienced adult CI users are consistent with clinical observations, showing large differences in functional abilities and large variability. Normative CIQOL data for adult CI users have the potential to enhance preoperative discussions with CI candidates, improve post-CI activation monitoring, and establish standards for CI centers.

Revisiting the Concept of Minimal Detectable Change for Patient-Reported Outcome Measures.

Interpreting change is a requisite component of clinical decision making for physical therapists. Physical therapists often interpret change using minimal detectable change (MDC) values. Current MDC formulas are informed by classical test theory and calculated with group-level error data. This approach assumes that measurement error is the same across a measure's scale and confines the MDC value to the sample characteristics of the study. Alternatively, an item response theory (IRT) approach calculates separate estimates of measurement error for different locations on a measure's scale. This generates a conditional measurement error for someone with a low, middle, or high score. Error estimates at the measure-level can then be used to determine a conditional MDC (cMDC) value for individual patients based on their unique pre- and post-score combination. cMDC values can supply clinicians with a means for using individual score data to interpret change scores while providing a personalized approach that should lower the threshold for change compared with the MDC and enhance the precision of care decisions by preventing misclassification of patients. The purpose of this Perspective is to present how IRT can address the limitations of MDCs for informing clinical practice. This Perspective demonstrates how cMDC values can be generated from item-level psychometrics derived from an IRT model using the patient-reported Activities-specific Balance Scale (ABC) commonly used in stroke rehabilitation and also illustrates how the cMDC compares to the MDC when accounting for changes in measurement error across a scale. Theoretical patient examples highlight how reliance on the MDC value can result in misclassification of patient change and how cMDC values can help prevent this from occurring. This personalized approach for interpreting change can be used by physical therapists to enhance the precision of care decisions.

Examining the Clinical Utility of the Brief Interview for Mental Status.

The Brief Interview for Mental Status (BIMS) is used to identify delirium and needed supports in patients living in skilled nursing facilities (SNFs) and long-term care facilities (LTCFs). We analyzed 3,537,404 patients discharged from acute hospitals to SNFs or LTCFs with factor and Rasch analyses to examine the clinical utility of the BIMS. More than 40% of the sample had maximum scores, indicating a ceiling effect. "Repetition of three words" was the easiest and the only misfit item (Outfit = 3.14). The ability of the BIMS to distinguish individuals into two cognitive levels (with person strata of 1.48) was limited. Although the BIMS is a widely used screening tool for cognitive impairment, we found it lacked sensitivity for approximately one half of patients admitted to SNFs/LTCFs. Our results suggest the BIMS should be interpreted with caution, particularly for patients with mild cognitive impairment. [Research in Gerontological Nursing, 15(3), 124-130.].

Effect of novel training to normalize altered finger force direction post-stroke: study protocol for a double-blind randomized controlled trial.

BACKGROUND: Functional task performance requires proper control of both movement and force generation in three-dimensional space, especially for the hand. Control of force in three dimensions, however, is not explicitly treated in current physical rehabilitation. To address this gap in treatment, we have developed a tool to provide visual feedback on three-dimensional finger force. Our objective is to examine the effectiveness of training with this tool to restore hand function in stroke survivors. METHODS: Double-blind randomized controlled trial. All participants undergo 18 1-h training sessions to practice generating volitional finger force of various target directions and magnitudes. The experimental group receives feedback on both force direction and magnitude, while the control group receives feedback on force magnitude only. The primary outcome is hand function as measured by the Action Research Arm Test. Other outcomes include the Box and Block Test, Stroke Impact Scale, ability to direct finger force, muscle activation pattern, and qualitative interviews. DISCUSSION: The protocol for this clinical trial is described in detail. The results of this study will reveal whether explicit training of finger force direction in stroke survivors leads to improved motor control of the hand. This study will also improve the understanding of neuromuscular mechanisms underlying the recovery of hand function. TRIAL REGISTRATION: ClinicalTrials.gov NCT03995069 . Registered on June 21, 2019.

Concomitant sensory stimulation during therapy to enhance hand functional recovery post stroke.

BACKGROUND: Post-stroke hand impairment is prevalent and persistent even after a full course of rehabilitation. Hand diminishes stroke survivors' abilities for activities of daily living and independence. One way to improve treatment efficacy is to augment therapy with peripheral sensory stimulation. Recently, a novel sensory stimulation, TheraBracelet, has been developed in which imperceptible vibration is applied during task practice through a wrist-worn device. The objective of this trial is to determine if combining TheraBracelet with hand task practice is superior to hand task practice alone. METHODS: A double-blind randomized controlled trial will be used. Chronic stroke survivors will undergo a standardized hand task practice therapy program (3 days/week for 6 weeks) while wearing a device on the paretic wrist. The device will deliver TheraBracelet vibration for the treatment group and no vibration for the control group. The primary outcome is hand function measured by the Wolf Motor Function Test. Other outcomes include the Box and Block Test, Action Research Arm Test, upper extremity use in daily living, biomechanical measure of the sensorimotor grip control, and EEG-based neural communication. DISCUSSION: This research will determine clinical utility of TheraBracelet to guide future translation. The TheraBracelet stimulation is delivered via a wrist-worn device, does not interfere with hand motion, and can be easily integrated into clinical practice. Enhancing hand function should substantially increase stroke survivors' independence and quality of life and reduce caregiver burden. TRIAL REGISTRATION: NCT04569123 . Registered on September 29, 2020.

Using Measurement to Highlight Occupational Therapy's Distinct Value.

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

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

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

Measurement Precision and Efficiency of Computerized Adaptive Testing for the Activities-specific Balance Confidence Scale in People With Stroke.

OBJECTIVE: Administrative burden often prevents clinical assessment of balance confidence in people with stroke. A computerized adaptive test (CAT) version of the Activities-specific Balance Confidence Scale (ABC CAT) can dramatically reduce this burden. The objective of this study was to test balance confidence measurement precision and efficiency in people with stroke with an ABC CAT. METHODS: We conducted a retrospective, cross-sectional, simulation study with data from 406 adults approximately 2 months post-stroke in the Locomotor-Experience Applied Post-Stroke trial. Item parameters for CAT calibration were estimated with the Rasch model using a random sample of participants (n = 203). Computer simulation was used with response data from the remaining 203 participants to evaluate the ABC CAT algorithm under varying stopping criteria. We compared estimated levels of balance confidence from each simulation to actual levels predicted from the Rasch model (Pearson correlations and mean standard error [SE]). RESULTS: Results from simulations with number of items as a stopping criterion strongly correlated with actual ABC scores (full item, r = 1, 12-item, r = 0.994; 8-item, r = 0.98; 4-item, r = 0.929). Mean SE increased with decreasing number of items administered (full item, SE = 0.31; 12 item, SE = 0.33; 8 item, SE = 0.38; 4 item, SE = 0.49). A precision-based stopping rule (mean SE = 0.5) also strongly correlated with actual ABC scores (r = 0.941) and optimized the relationship between number of items administrated with precision (mean number of items 4.37, range [4-9]). CONCLUSION: An ABC CAT can determine accurate and precise measures of balance confidence in people with stroke with as few as 4 items. Individuals with lower balance confidence may require a greater number of items (up to 9) which could be attributed to the Locomotor-Experience Applied Post-Stroke trial excluding more functionally impaired persons. IMPACT: Computerized adaptive testing can drastically reduce the ABC test's administration time while maintaining accuracy and precision. This should greatly enhance clinical utility, facilitating adoption of clinical practice guidelines in stroke rehabilitation. LAY SUMMARY: If you have had a stroke, your physical therapist will likely test your balance confidence. A CAT version of the ABC scale can accurately identify balance with as few as 4 questions, which takes much less time.

Using Measurement to Highlight Occupational Therapy's Distinct Value.

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

Piloting an empirical approach to link the international classification of functioning, disability, and health to job demand classification.

BACKGROUND: The Social Security Administration has a thorough disability claims process, though one goal is to process claims more efficiently. This pilot described the creation and trial of a web-based tool to assist this process. OBJECTIVE: To empirically link the International Classification of Functioning, Disability and Health (ICF) model to the Occupational Information Network (O*NET) with a self-reported activity measure (physical domain). METHODS: ICF Activity domains and item difficulty calibrations were obtained from a self-reported ICF-Activity Measure. Three work/disability experts matched measurement constructs, job names, and item difficulties with job demands. Item difficulties were linked for "Positioning and Transfer" with O*NET data values of "Stamina"; "Trunk Strength", and "Walking and Moving" with O*NET data values of "Stamina." The system was then pilot tested with 14 adults with more than one activity challenges. RESULTS: An average total of 613 jobs were generated per participant and each job was categorized into one of 16 job clusters. Person ability measures and constructs were significant predictors for numbers of job (R2 = 0.92, p < 0.05). Participants demonstrated moderate satisfaction with program usability, and reported capability in performing jobs. CONCLUSIONS: The system provides a feasible means to assist disability examiners and claimants in identifying relevant job abilities and options.

Cochlear Implant Quality of Life (CIQOL): Development of a Profile Instrument (CIQOL-35 Profile) and a Global Measure (CIQOL-10 Global).

Purpose Valid, reliable, and efficient patient-reported outcome measures are needed to quantify quality of life (QOL) outcomes after cochlear implantation to supplement information obtained from performance-based outcomes. We previously developed the Cochlear Implant Quality of Life (CIQOL) item bank to serve as the source of items for subsequent instruments. This study reports the development and psychometric properties for 2 of these new instruments, the CIQOL-35 Profile and the CIQOL-10 Global. Method Cochlear implant (CI) users referred from the CIQOL Development Consortium (n = 371), consisting of 20 CI centers across the United States, provided responses to the 81-item CIQOL item bank, which are grouped into 6 QOL domains (communication, emotional, entertainment, environment, listening effort, and social). Responses to the 81 CIQOL items were analyzed using item response theory to determine individual item difficulty, discrimination, and model fit to select the set of items for the profile instrument and global measure that would optimize their measurement characteristics. Results The 35-item CIQOL-35 Profile instrument assesses outcomes represented in the 6 domains of the CIQOL final item pool. The 10-item CIQOL-10 Global measure produces a single, overall QOL score. After ensuring the upper and lower ends of the item difficulty continuum were represented (item difficulty range: -2.48 to 2.47), the items with the highest discrimination ability for each domain were selected for the CIQOL-35 Profile instrument (discrimination range: 0.67-1.37). Items were selected for the CIQOL-10 Global measure in a similar manner. Conclusion The CIQOL-35 Profile and CIQOL-10 Global instruments provide psychometrically sound and efficient measures that can be used to assess QOL in adult CI users in both clinical and research settings. Supplemental Material https://doi.org/10.23641/asha.9745010.

Association of Demographic and Hearing-Related Factors With Cochlear Implant-Related Quality of Life.

Importance: Only limited evidence is available describing the contribution of patient-related factors to quality of life in adults with cochlear implants. Objective: Assess the association between demographic, hearing-related, and cochlear implant-related factors and quality of life by using a new Cochlear Implant Quality of Life (CIQOL) item bank, which was developed to meet rigorous psychometric standards. Design, Setting, and Participants: Multicenter cross-sectional study of adults 18 to 89 years of age who had at least 1 year of cochlear implant use and who were recruited through a consortium of 20 cochlear implant centers in the United States. Using an online format, questionnaires were sent to the first 500 participants who contacted the research team. Of these participants, 371 (74.2%) completed the questionnaire. Demographic, hearing-related, and cochlear implant-related data were obtained along with responses to each of the 81 items in the CIQOL item bank. Multivariable linear regression was used to examine demographic, hearing-related, and cochlear implant-related factors associated with scores in each of the 6 CIQOL domains (communication, emotional, entertainment, environment, listening effort, and social). Main Outcomes and Measures: Association among demographic, hearing-related, and cochlear implant-related factors and CIQOL scores for each of 6 domains. Results: Of the 371 participants who completed the questionnaire, 222 (59.8%) were women, and the mean (SD) age was 59.5 (14.9) years. The CIQOL scores were normally distributed across the 6 domains. Being employed, having higher household income, longer duration of hearing loss prior to cochlear implantation, and having bilateral rather than unilateral cochlear implantation were associated with higher CIQOL scores in 1 or more domains, but the effect size varied widely (ß, 0.1-6.9). Better sentence recognition ability (using AzBio to measure speech recognition) was associated with only a small positive effect size for the communication (ß, 0.0 [95% CI, 0.0-0.1]), entertainment (ß, 0.0 [95% CI, 0.0-0.1]), and environmental (ß, 0.0 [95% CI, 0.0-0.0]) domains. Increased age was associated with lower CIQOL in the entertainment domain (ß, -0.3 [95% CI, -1.5 to -0.4]). The demographic, hearing-related, and cochlear implant-related factors included in the multivariable regression models accounted for only a small percentage of the variance in CIQOL domain scores (R2, 0.08-0.17). Conclusions and Relevance: Several factors were found to predict higher or lower CIQOL scores in specific domains, with speech-recognition ability having only a minimal association. Despite evaluating a large number of demographic, hearing-related, and cochlear implant-related factors, the multivariable models accounted for only a small amount of CIQOL variance. This suggests that patient or other characteristics that contribute to cochlear implant-related quality of life remain largely unknown.

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

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

Interpreting Action Research Arm Test Assessment Scores to Plan Treatment.

Rasch keyforms can help interpret clinical assessment scores. The Action Research Arm Test (ARAT) is a commonly used assessment, yet no keyform currently exists. The aim is to provide a keyform for the ARAT and demonstrate how a clinician can use the keyform to design optimally challenging rehabilitation sessions. Secondary analysis of ARAT data ( n = 122) using confirmatory factor and Rasch analyses were used to examine the measurement properties and generate a keyform. The item standardized factor loadings were >0.40 (range = 0.82-0.96) and R2 values were >.60 (range = .65-.96). All items exhibited adequate infit statistics with point measure correlations >.60 (range = .72-.97). Person reliability was .98, and person separation was 7.07. Item-difficulty measures ranged from -2.78 logits to 2.64 logits. The ARAT has strong measurement properties, and a keyform was provided. We showed how the keyform can be utilized by clinicians to interpret scores, set goals, and plan treatment.

Rasch Analysis of the Activities-Specific Balance Confidence Scale in Individuals Poststroke.

OBJECTIVE: To examine the psychometric properties of the Activities-specific Balance Confidence (ABC) scale using Rasch analysis for individuals poststroke. DESIGN: Retrospective cohort. SETTING: Data was extracted from the Locomotor Experience Applied Post-Stroke phase 3, multisite, randomized controlled clinical trial. PARTICIPANTS: Community-dwelling, ambulatory, older adults (N = 406) (mean age ± SD, 61.97±12.76y; 45.07% female) approximately 2 months poststroke. INTERVENTION: None. MAIN OUTCOME MEASURES: We examined unidimensionality, local dependence, rating-scale structure, item and person fit, person-item match, and separation index of the ABC scale. RESULTS: Confirmatory and exploratory factor analysis showed the ABC scale was adequately unidimensional and 3-item pairs had local dependence. A collapsed 5-category rating scale was superior to the 101-category scale. The hardest item was "walking outside on an icy sidewalk," the easiest item was "getting into or out of a car," and no items misfit. The ABC scale had high person reliability (0.93), despite 10.5% of individuals misfitting the expected response pattern. Mean ability level of the sample was slightly lower (-0.56 logits) than the mean item difficulty indicating that the ABC scale adequately matched our sample's balance confidence. The ABC scale did not have a floor or ceiling effect and separated individuals into 5 statistically distinct strata (separation index = 3.71). CONCLUSIONS: The Rasch model supports the use of the ABC scale to measure balance confidence in individuals poststroke. The consistency of our results with previous Rasch analyses on the ABC scale demonstrates the instrument responds similarly across multiple populations; community-dwelling older-adults, outpatient orthopedic physical therapy, stroke, Parkinson disease, and lower-limb amputation. Recommendations include collapsing the rating scale and developing a computerized-adaptive test version of the scale to enhance clinical utility.