The Flare-OA-16 questionnaire measuring flare in knee and hip osteoarthritis in the patient perspective: scale reduction and validation using a Rasch model.

OBJETIVE: The recent Flare-OA questionnaire measuring flare in knee and hip osteoarthritis (OA) (19 items in 5 domains, numerical rating scale) showed good psychometric properties along with classical test theory. This study aimed to determine its scaling properties by Rasch analysis and to present evidence for a refined scalable version. STUDY DESIGN AND SETTING: The participants were 398 subjects (mean age 64 years (SD=8.1), 70.4% women) recruited from Australia, France, and the United States, with clinically and radiologically symptomatic knee or hip OA, who completed an online survey. The sample was split into derivation and validation subsamples, stratified by country and joint. Rasch analysis examined differential item functioning (DIF) for sex, age, country and joint. A confirmatory factor analysis (CFA) and an analysis of convergent validity were performed to document the psychometric properties of the short version. RESULTS: To fit the Rasch model, we reordered thresholds of answering modalities when necessary. Two items were removed. A local dependency between 2 items was solved by combining items modalities into a super-item. A uniform DIF (expected and non-removed) was identified for one item that was split by joint, and a non-uniform DIF for one item for age and country (removed). The person-item threshold distribution showed a well focused scale; the CFA and the analysis of convergent validity showed good fit indicators for the short version. CONCLUSIONS: The Rasch analysis was helpful in guiding the decision to refine the measurement instrument. After analysis, the Flare-OA-16 questionnaire self-report questionnaire is available for use in clinical research.

Activities-specific balance confidence scale: a Rasch evaluation of the Arabic version in lower-limb prosthetic users.

PURPOSE: To evaluate the psychometric properties of the Arabic version of the Activities-Specific Balance Confidence Scale using the 5-option response categories for individuals with lower limb amputation (ABC-5/Ar). MATERIALS AND METHODS: This was a methodological study on a convenience sample of individuals with unilateral lower-limb amputation attending outpatient rehabilitation centres in Saudi Arabia and Turkey (N = 155). Rasch analysis (WINSTEPS version 4.6.5) was used to examine the 5-categories rating scale structure, item fit, item difficulty hierarchy, person separation index, unidimensionality, local item dependency, and differential item functioning. RESULTS: The ABC-5/Ar 5-response option demonstrated an appropriate model fit. Most items fit the Rasch model, except for item #12 "walk in a crowded mall," which showed an overfitting value of 0.63. The person separation indices 2.95 (Cronbach's α = 0.96). Principal component analysis of residuals confirmed the unidimensionality of the scale; however, local dependency was detected between item #14 "Ride in escalator holding rail," and item #15 "Ride in escalator not holding rail." CONCLUSIONS: The findings suggest that the ABC-5/Ar shows promise in assessing balance confidence in Arabic-speaking lower-limb prosthesis users. However, further studies with larger sample sizes and in diverse clinical contexts are needed to confirm its effectiveness in various clinical settings.

Overall, our Rasch-based study provides additional evidence to support the psychometric appropriateness of using the Activity-specific Balance Confidence scale with the 5-category options (ABC-5) of the Arabic version among lower prosthesis users.Clinicians and researchers should be mindful of cultural and contextual differences that exist among Arabic-speaking population which may influence how participants responded to certain items in the scale.It is essential to conduct a comprehensive psychometric evaluation to guide the implementation and interpretation of scales, particularly in Arabic-speaking countries due to the scarcity of validated and standardised outcome measures to assess prosthesis users' confidence.

Selecting PedsQL items to derive the PedsUtil health state classification system to measure health utilities in children.

BACKGROUND: There is a lack of preference-based health-related quality of life (HRQoL) measures that consistently value health across a full range of child age groups. The PedsQL is a generic HRQoL instrument validated for children 2-18 years, but it is not preference-based. The objective of this study was to derive the PedsUtil health state classification system from the PedsQL as a basis for a preference-based HRQoL measure for children. METHODS: A two-step process was used to select PedsQL items to include in the health state classification system: 1) exclude poorly functioning items according to Rasch analysis in each of the previously established seven dimensions of the PedsUtil health state classification system and 2) select a single item to represent each dimension based on Rasch and psychometric analyses, as well as input from child health experts and parents. All secondary analyses were conducted using data from the Longitudinal Study of Australian Children (LSAC). Analyses were stratified by age group (i.e., 2-5 years, 6-13 years, and 14-17 years) to represent the different developmental stages of children and to reflect the study design of the LSAC. Rasch analyses were also performed on five random subsamples for each age group to enhance robustness of results. RESULTS: Twelve items were excluded from the PedsUtil health state classification system after the first step of the item selection process. An additional four items were excluded in the second step, resulting in seven items that were selected to represent the seven dimensions of the PedsUtil health state classification system: Physical Functioning ("participating in sports activity or exercise"), Pain ("having hurts or aches"), Fatigue ("low energy level"), Emotional Functioning ("worrying about what will happen to them"), Social Functioning ("other kids not wanting to be their friend"), School Functioning ("keeping up with schoolwork"), and School Absence ("missing school because of not feeling well"). CONCLUSIONS: The PedsUtil health state classification system was derived from the PedsQL based on several criteria and was constructed to be applicable to children two years and older. Research is ongoing to elicit preferences for the PedsUtil health state classification system to construct the PedsUtil scoring system.

Validity and reliability of the Yonsei lifestyle profile-active, balance, connection, diversity.

INTRODUCTION: Lifestyle, defined as a way of living resulting from an individual's deliberate choices, is a crucial factor in improving and maintaining health. Consequently, the measurement and analysis of lifestyle are of significant importance. This study aims to validate the validity and reliability of the Yonsei Lifestyle Profile-Active, Balance, Connection, Diversity (YLP-ABCD) in measuring health-related lifestyles. METHODS: Data were collected from 300 participants aged 55 and older using the YLP-ABCD. To analyse the validity and reliability of the YLP-ABCD, analysed using frequency, descriptive statistics, confirmatory factor analysis, and Rasch model analysis. RESULTS: The results indicate that the YLP-ABCD, which consists of 35 items, demonstrates unidimensionality and local independence. The Rasch model confirmed the suitability of the 5-point Likert scale for the factors, excluding subfactors Balanced and Unbalanced. The item fit criteria (0.5 < MNSQ < 1.5) were met for all items. The distribution of the respondents' abilities suggests the need for additional items to measure their ability levels. Both the item and respondent separation indices and their reliabilities were satisfactory. CONCLUSION: This study confirmed the utility of the YLP-ABCD as a valuable tool for measuring and understanding the multifaceted diversity of lifestyles. Therefore, by utilising YLP-ABCD to quantitatively measure health lifestyles, we anticipate contributing to improvements in human health and quality of life.

Validation of the Maslach Burnout Inventory-General Survey 9-item short version: psychometric properties and measurement invariance across age, gender, and continent.

Background: The Maslach Burnout Inventory-General Survey (MBI-GS) stands as the preeminent tool for assessing burnout across various professions. Although the MBI-GS9 emerged as a derivative of the MBI-GS and has seen extensive use over several years, a comprehensive examination of its psychometric properties has yet to be undertaken. Methods: This study followed the Standards for Educational and Psychological Testing guidelines to validate the MBI-GS9. Employing a combined approach of classical test theory and item response theory, particularly Rasch analysis, within an integrated framework, the study analyzed data from 16,132 participants gathered between 2005 and 2015 by the Centre for Organizational Research at Acadia University. Results: The findings revealed that the MBI-GS9 exhibited satisfactory reliability and validity akin to its predecessor, the MBI-GS. Across its three dimensions, Cronbach's α and omega coefficients ranged from 0.84 to 0.91. Notably, the MBI-GS9 displayed no floor/ceiling effects and demonstrated good item fit, ordered threshold, acceptable person and item separation and reliability, clear item difficulty hierarchy, and a well-distributed item threshold. However, the results suggested a recommended minimum sample size of 350 to mitigate potential information loss when employing the MBI-GS9. Beyond this threshold, the observed mean difference between the MBI-GS and MBI-GS9 held minimal practical significance. Furthermore, measurement equivalence tests indicated that the MBI-GS9 maintained an equivalent three-factor structure and factor loadings across various gender, age, and continent groups, albeit with inequivalent latent values across continents. Conclusion: In sum, the MBI-GS9 emerges as a reliable and valid alternative to the MBI-GS, particularly when utilized within large, diverse samples across different age and gender demographics. However, to address potential information loss, a substantial sample size is recommended when employing the MBI-GS9. In addition, for cross-cultural comparisons, it is imperative to initially assess equivalence across different language versions at both the item and scale levels.

Improving Heckmatt muscle ultrasound grading scale through Rasch analysis.

The 4-point Heckmatt grading scale can easily be used to analyze muscle ultrasound images. The scale is used in an expanding set of muscles and neuromuscular disorders. This prompted the need for evaluation of the measurement properties of the scale in its current form. In this retrospective observational study we included muscle ultrasound images from patients who were undergoing an ultrasound exam for either clinical or research purposes. The primary outcome of this study was to investigate and improve the measurement properties of the Heckmatt scale using Rasch analysis. We investigated whether observers consistently used the 4 response categories. Data was available of 30.967 muscle ultrasound images from 1783 patients and 43 different individual muscles. In 8 of the 43 muscles, observers had difficulty to discriminate between the response categories, especially in bulbar muscles. After rescoring to a 3-point scale, the response categories were consistently used in all 43 muscles. In conclusion, a 3-point Heckmatt grading scale leads to improved accurate scoring compared to the original 4-point Heckmatt grading scale. Using the 3-point Heckmatt grading scale will not only simplify the use of the scale but also enhance its application in clinical practice and research purposes.

Development and Evaluation of the Abdominal Pain Knowledge Questionnaire (A-PKQ) for Children and Their Parents.

BACKGROUND: Abdominal pain is a common and often debilitating issue for children and adolescents. In many cases, it is not caused by a specific somatic condition but rather emerges from a complex interplay of bio-psycho-social factors, leading to functional abdominal pain (FAP). Given the complex nature of FAP, understanding its origins and how to effectively manage this condition is crucial. Until now, however, no questionnaire exists that targets knowledge in this specific domain. To address this, the Abdominal Pain Knowledge Questionnaire (A-PKQ) was developed. METHODS: Two versions were created (one for children and one for parents) and tested in four gastroenterology clinics and one specialized pain clinic in Germany between November 2021 and February 2024. Children between 8 and 17 years of age (N = 128) and their accompanying parents (N = 131) participated in the study. Rasch analysis was used to test the performance of both versions of the questionnaire. RESULTS: The original questionnaires exhibited good model and item fit. Subsequently, both questionnaires were refined to improve usability, resulting in final versions containing 10 items each. These final versions also demonstrated good model and item fit, with items assessing a variety of relevant domains. CONCLUSION: The A-PKQ is an important contribution to improving assessment in clinical trials focused on pediatric functional abdominal pain.

Development and validation of a patient-reported outcome measure for hair loss treatment: The HAIR-Q.

BACKGROUND: Patient-reported outcome measures (PROMs) for hair loss focus mainly on Alopecia Areata. We created a PROM (i.e., HAIR-Q) that is applicable to any hair loss condition. The HAIR-Q measures satisfaction with hair. PATIENTS/METHODS: Concept elicitation interviews were conducted and analyzed to develop a draft scale. Content validity was established through multiple rounds of patient and expert input. Psychometric properties of the scale were examined in an online sample (i.e., Prolific) using Rasch measurement theory (RMT) analysis. Test-retest reliability and tests of construct validation were examined. RESULTS: Content validity of a 22-item draft scale was established with input from 11 patients, 12 experts and an online Prolific sample of 59 people who had a variety of hair loss treatments. In the RMT analysis (n = 390), 8 items were dropped. Data for the 14-item scale fit the Rasch model (χ2 = 89.85, df = 70, p = 0.06). All 14 items had ordered thresholds and good item fit. Reliability was high with person separation index and Cronbach alpha values ≥0.91, and intraclass correlation coefficient of 0.94 based on a sample of 97 participants. Higher (better) scores on the scale were associated with having more hair, looking younger than ones' age, satisfaction with hair overall, being less bothered by hair loss, and for those who had a hair loss treatment in the past year, being more satisfied with their hair now than before treatment (p < 0.001). CONCLUSION: The HAIR-Q evidenced reliability and validity and can be used in research and to inform clinical care to measure satisfaction with hair from the patient perspective.

Cross-cultural adaptation and validation of the caregiver self-efficacy in contributing to patient self-care scale in China.

BACKGROUND: Caregiver self-efficacy is crucial in improving patient outcomes and caregiver well-being, but there is a lack of suitable scales to assess this concept within the context of Chinese culture. This study aimed to cross-culturally translate the Caregiver Self-Efficacy in Contributing to Patient Self-Care (CSE-CSC) Scale and evaluate its psychometric properties using classical test theory and item response theory. METHODS: The CSE-CSC scale was adapted using Brislin's translation model after obtaining authorization from the original author. A multicenter, cross-sectional study was conducted to assess the psychometric properties of this scale. Classical test theory was used to evaluate reliability (internal consistency, test-retest reliability), validity (content validity, structural validity, convergent validity), and floor and ceiling effects. Item response theory was employed to assess the fit of the rating scale model, reliability, item difficulties, and measurement invariance. RESULTS: The translation and cultural adaptation process was completed. Classical test theory demonstrated good internal consistency (Cronbach's α = 0.935) and test-retest reliability (ICC from 0.784 to 0.829, p<0.001). The I-CVI and K* of each item ranged from 0.875 to 1.00 and 0.871 to 1.00. The first-order 2-factor model fit well (χ2/df = 3.71, RMSEA = 0.082, SRMR = 0.032, CFI = 0.973, TLI = 0.60). Convergent validity showed that the CSE-CSC scores had a strong positive correlation with three separate scales of the CC-SC-CII. There was no floor and ceiling effect in this scale. Rasch analysis showed that the CSE-CSC scale demonstrated a good fit to the rating scale model and exhibited excellent reliability (person/item separation index>2, person/item reliability coefficients>0.8). The Wright map showed that item difficulty matched the respondents' measured abilities. The analysis of differential item functioning (DIF) showed that all items were comparable in gender. CONCLUSIONS: This study indicated that the CSE-CSC scale had good reliability, validity, difficulty degree, and measurement invariance. The CSE-CSC scale can be used to measure caregiver self-efficacy of Chinese patients with multiple chronic conditions.

Rasch analysis of the self efficacy (SE-12) questionnaire measuring clinical communication skills.

Objective: The aim of this study was to examine the construct validity and reliability of the Self Efficacy (SE-12) questionnaire using Rasch analysis. Methods: The SE-12 was administered to Danish health care professionals prior to their participation in a communication skills training program. Analysis of fit to the Rasch model, ordering of response categories, dimensionality-testing, test for differential item functioning, test for local dependency, and calculation of reliability were used to evaluate the psychometric characteristics of the SE-12. Results: In this study, 1057 respondents were analyzed. Overall, the SE-12 demonstrated an acceptable fit to the Rasch model. Response categories were appropriately ordered for all twelve items. However, items 6 (structure) and item 8 (empathy) demonstrated differential item functioning, with men being more likely to affirm the first and women the last item. Local dependency was observed between five item groups but adjusting for these improved fit indices significantly. The SE-12 exhibited high reliability with PSI ranging from 0.92 to 0.94. A transformation table converting ordinal scores to interval scores is provided. Conclusion: The SE-12 demonstrates good construct validity and excellent reliability. Minor issues regarding local dependency and differential functioning require attention.Innovation: A 5-item version could be explored without compromising validity and reliability.

Validity of OSDI-6 questionnaire in a Chinese adult population.

This study aimed to evaluate the validity of the Chinese translation version of OSDI-6 (C-OSDI-6) using a virtual set-up questionnaire for dry eye disease. A total of 270 participants (136 males, 50.4% and 134 females, 49.6%) with a mean age of 28.22 ± 9.01 years were assessed, diagnosed under the criteria put forth by Dry Eye Workshop completed the Chinese translated version of the OSDI-12 questionnaire (C-OSDI-12). Validity and psychometric properties were analyzed using the study data on the selected items (a new approach called virtual validation). The six items were extracted from the C-OSDI-12 as suggested by the authors of OSDI-6 and compared. The total scores of C-OSDI-12 and C-OSDI-6 were 30.27 ± 13.19 and 6.95 ± 3.53, respectively. Significant reliability was found between the total C-OSDI-6 score and the total C-OSDI-12 score (r = 0.865, p < 0.001). Infits and outfits of the C-OSDI-6 were between 1.26 and 0.78.The C-OSDI-6 proved valid and psychometrically responsive in Chinese adult dry eye participants. The findings of this virtual validation study need to be confirmed in a longitudinal validation study on real-world use.

Development of a quality of life measure for left ventricular assist device recipients using a mixed methods approach.

BACKGROUND: Left ventricular assist device (LVAD) recipients report symptom improvement but find adjusting to life with the LVAD challenging. These challenges are unique, and existing patient-reported outcome measures (PROMs) do not reflect their experiences. This study aimed to develop a culturally relevant quality of life PROM for use with LVAD recipients in future research, design evolutions and clinical practice. METHODS: A three-stage mixed-methods approach was used to develop a PROM: stage 1 included group concept mapping (GCM); stage 2 semi-structured qualitative interviews were conducted with 11 LVAD recipients and 10 clinicians, and a questionnaire was developed using a conceptual framework; and stage 3 used exploratory psychometric analysis of the PROM data using Rasch measurement theory. This paper presents stages 2 and 3. RESULTS: The conceptual framework consisted of four key concepts, including general health, life with the LVAD, equipment and clothing and emotional impact. Statements from interviews and GCM were used to create items for the LVAD quality of life (LVAD-QoL). Cognitive interviews tested face validity and participant comprehension. Forty-nine participants were recruited from three UK transplant centres. PROM data were collected and analysed using Rasch analysis. Four items displayed misfit; dependency between item sets was the biggest issue (57/485 pairwise differences). After restructuring and dealing with item misfit, the LVAD-QoL conformed to the Rasch model, supporting the psychometric properties and quality of the LVAD-QoL. CONCLUSIONS: Using a mixed-methods approach ensured the development of a robust and psychometrically sound tool for research, design evolution and clinical practice with LVAD recipients.

The Night Eating Questionnaire through the lens of the Rasch model.

Previous research focused on the conventional approaches to test psychometric characteristics of the Night Eating Questionnaire (NEQ). The purpose of this research was to examine the psychometric properties of the Night Eating Questionnaire using the Rasch model in a sample of university students. The study was carried out from November 2018 to March 2019 on 300 students in health sciences at the University of Pristina temporarily seated in Kosovska Mitrovica, who completed the NEQ. A confirmatory factor analysis (CFA) suggested that the Serbian version mirrored the original NEQ structure: Goodness of fit index = 0.978, Comparative fit index = 0.996, Tucker-Lewis index = 0.995, Root Mean Square Error of Approximation = 0.011 and Standardized Root Mean Square Residual = 0.057. The Cronbach's alpha coefficient for the total scale was 0.627. The Rasch analysis showed that the item separation index classified the items into six groups based on their level of difficulty. The person reliability index separated well night eaters from day eaters. Few items did not fit the adequate range for the infit/outfit statistics. Overall, there were several groups of NEQ items that have a distinctive difficulty level, but the difference was not a remarkable one. This means that most students did not have night eating syndrome (NES), despite various levels of item difficulty. The NEQ performs well in the efforts to distinguish people who eat and do not eat at night. Most students reported conventional eating patterns and only a few had NES. The properties of the NEQ warrant its use in further night eating research.

Rasch analysis of the pre-sleep arousal scale in patients with acute insomnia disorder.

BACKGROUND: Hyperarousal plays an essential role in the initiation and maintenance of insomnia, highlighting the need for a tool that measure the hyperarousal state during the early course of insomnia. Pre-sleep Arousal Scale (PSAS) is a self-report questionnaire to evaluate subjective pre-sleep arousal of insomnia. The aim of this study was to examine the psychometric properties of the PSAS among patients with acute insomnia disorder (AID) using Rasch analysis. METHODS: Totally 170 patients with AID from 31 public hospitals in China were recruited and completed the test. The psychometric properties of the PSAS were tested using Rasch analysis by Winsteps v5.4.1.0, including unidimensionality, local item independence, item fit, category diagnostics, reliability, item-person maps and differential item functioning (DIF) by age and gender. RESULTS: According to Rasch analysis, somatic and cognitive subscales were unidimensional and basically demonstrated good item-fit statistics. 4-point Likert scale may be more appropriate for PSAS. All items have a good reliability and separation. No gender and age bias were detected for the scale. However, the person arousal level is not well matched to item difficulty. CONCLUSION: The present study further reveals appropriate psychometric properties of the PSAS in patients with AID and provides suggestions for refinements and supplements to the PSAS.

Development and psychometric evaluation of the adjuvant endocrine therapy beliefs scale for breast cancer survivors.

PURPOSE: Adjuvant endocrine therapy has a vital role in reducing breast cancer mortality. The beliefs in adjuvant endocrine therapy is a very important factor in the medication adherence of breast cancer survivors. Therefore, it is necessary to develop a standardized scale for assessment of adjuvant endocrine therapy. The purpose of this study was to identify the attributes of adjuvant endocrine therapy beliefs, and to evaluate adjuvant endocrine therapy beliefs scale psychometric properties. METHODS: A hybrid model was applied to identify the concept of adjuvant endocrine therapy beliefs and measurement question were developed by the scale development process. Statistical analysis using validity analysis and Rasch analysis based on item response theory were performed. A total of 228 breast cancer survivors in South Korea participated in the study. RESULTS: The finally developed adjuvant endocrine therapy beliefs scale consisted of 22 items. The items extracted by 4 factors explained 59.72% of the total variance. The model fit showed an acceptable level. The adjuvant endocrine therapy beliefs scale was excellent in convergent and discriminant validity with reliability. CONCLUSION: This scale is expected to be practical and useful in identifying adjuvant endocrine therapy beliefs and developing intervention strategies to promote adjuvant endocrine therapy adherence. In addition, continuous education and support should be accompanied so that breast cancer survivors can maintain positive beliefs in adjuvant endocrine therapy adherence.

A scoping review to create a framework for the steps in developing condition-specific preference-based instruments de novo or from an existing non-preference-based instrument: use of item response theory or Rasch analysis.

BACKGROUND: There is no widely accepted framework to guide the development of condition-specific preference-based instruments (CSPBIs) that includes both de novo and from existing non-preference-based instruments. The purpose of this study was to address this gap by reviewing the published literature on CSPBIs, with particular attention to the application of item response theory (IRT) and Rasch analysis in their development. METHODS: A scoping review of the literature covering the concepts of all phases of CSPBI development and evaluation was performed from MEDLINE, Embase, PsychInfo, CINAHL, and the Cochrane Library, from inception to December 30, 2022. RESULTS: The titles and abstracts of 1,967 unique references were reviewed. After retrieving and reviewing 154 full-text articles, data were extracted from 109 articles, representing 41 CSPBIs covering 21 diseases or conditions. The development of CSPBIs was conceptualized as a 15-step framework, covering four phases: 1) develop initial questionnaire items (when no suitable non-preference-based instrument exists), 2) establish the dimensional structure, 3) reduce items per dimension, 4) value and model health state utilities. Thirty-nine instruments used a type of Rasch model and two instruments used IRT models in phase 3. CONCLUSION: We present an expanded framework that outlines the development of CSPBIs, both from existing non-preference-based instruments and de novo when no suitable non-preference-based instrument exists, using IRT and Rasch analysis. For items that fit the Rasch model, developers selected one item per dimension and explored item response level reduction. This framework will guide researchers who are developing or assessing CSPBIs.

Measurement properties of the Thai translation of the Recovery Assessment Scale - Domains and Stages (RAS-DS) and comparison of recovery experiences between Thai and Australian consumers living with serious mental illness.

Personal recovery, a western conceptualisation that focuses on hope and living meaningful lives of choice rather than focusing on symptom reduction, is a more recent concept in many Asian countries including Thailand. One way to promote recovery-oriented service delivery is to use outcome measures that capture self-reported personal recovery. This study aimed to evaluate a Thai translation of a self-report measure of mental health recovery, the Recovery Assessment Scale - Domains and Stages (RAS-DS). The study also explored the cultural similarities and differences between Thai (n = 190) and Australian (n = 301) recovery experiences by comparing Thai and Australian participant responses to RAS-DS items. Data were analysed using Rasch analysis. Analyses revealed that the Thai version of the RAS-DS had adequate measurement properties. Cultural comparisons suggested that most aspects contained within the RAS-DS appear to be applicable across both Thai and Australian contexts. Three findings suggest linguistic or cultural differences in Thai and Australian recovery experiences: (i) a ceiling effect for Thai participants, (ii) some items were "harder" or "easier" for one cultural group to endorse than the other, and (iii) a few items were "misfitting" for Thai participants.

Validation of a Tamil Version of the Five Facet Mindfulness Questionnaire Using Rasch Analysis.

Background: Various assessment tools that explore and assess mindfulness are available. Keeping in view both the origin of and the literature surrounding mindfulness assessment tools, this study aimed to evaluate the workability of one widely researched tool, the Five Facet Mindfulness Questionnaire (FFMQ), for establishing cross-cultural generalizability and utility in the Indian context. Methods: We recruited 303 adults over 18 with proficiency in the Tamil language and no history of significant neurological trauma and/or psychiatric history. They completed a version of the 39-item FFMQ, which we had translated into Tamil (FFMQ-T). The psychometric properties of this scale were tested using the Partial-Credit model of Rasch analysis. Results: Iterative Rasch analysis could not resolve consistent misfit of the Observe facet items. Using a subtest approach, a higher-order fit of the FFMQ-T could be achieved after the deletion of additional items from each of the remaining four facets. The resulting final model for the FFMQ-T questionnaire was a four-factor solution with 22 items. Conclusions: This study concluded the usability of the new 22-item FFMQ-T. These results are not dissimilar to the other versions in similar populations, such as the Hindi version of the FFMQ. The ordinal-to-interval conversion tables provided here ensure that the FFMQ-T can be used with enhanced precision and parametric statistics.

Development and validation of a patient reported experience measure for experimental cancer medicines (PREM-ECM) and their carers (PREM-ECM-Carer).

BACKGROUND: Our aim was to develop a validated Patient Reported Experience Measure (PREM) to capture patient and carer experience during participation in experimental cancer medicine trials (ECM): called PREM-ECM. METHODS: Mixed method design, consisting of four stages. Questionnaire items were produced for both patients and carers using interviews, focus groups, and cognitive interviews with patients and carers separately. For both patient and carer PREMs, a cross-sectional questionnaire study was conducted to identify final items for inclusion using hierarchical item reduction and Rasch analysis. Questionnaire validity and reliability were assessed, including administration feasibility. RESULTS: Initial interview participants suggested the need for three PREMs, two specific to patients: (i) a 'prior' questionnaire that captured experiences of trial introduction, screening, consenting, and early trial experience (< 6 weeks post consent); and (ii) 'on-trial' that captured experiences of ongoing consent and trial participation; and (iii) a PREM specific for carers. The draft 25-item 'prior' questionnaire was completed by 162 patients and 162 patients completed the draft 35-item 'on-trial' questionnaire. Hierarchical and Rasch analysis produced a 14-item 'prior' list and a 15-item list for 'on-trial'. Both patient PREM's demonstrated a good fit to the Rasch model following Bonferroni correction (X2p = 0.008). The carer 34-draft item questionnaire was completed by 102 participants. Hierarchical and Rasch analysis produced a 13-item list for PREM-ECM-Carer, with good fit to the Rasch model ( X2p = 0.62). The pilot testing demonstrated the feasibility of all the PREMs in capturing patient and caregiver experiences in routine clinical settings. CONCLUSIONS: The three PREM-ECM questionnaires will be the first validated experience measures for ECM trial patients and their carers. These questionnaires may be used to assess patients' and their carers' experiences of ECM and enable robust comparisons across cancer trial units highlighting areas for service improvement.

A Psychometric Evaluation of the Dysphagia Handicap Index Using Rasch Analysis.

Background/Objectives: The Dysphagia Handicap Index (DHI) is commonly used in oropharyngeal dysphagia (OD) research as a self-report measure of functional health status and health-related quality of life. The DHI was developed and validated using classic test theory. The aim of this study was to use item response theory (Rasch analysis) to evaluate the psychometric properties of the DHI. Methods: Prospective, consecutive patient data were collected at dysphagia or otorhinolaryngology clinics. The sample included 256 adults (53.1% male; mean age 65.2) at risk of OD. The measure's response scale, person and item fit characteristics, differential item functioning, and dimensionality were evaluated. Results: The rating scale was ordered but showed a potential gap in the rating category labels for the overall measure. The overall person (0.91) and item (0.97) reliability was excellent. The overall measure reliably separated persons into at least three distinct groups (person separation index = 3.23) based on swallowing abilities, but the subscales showed inadequate separation. All infit mean squares were in the acceptable range except for the underfitting for item 22 (F). More misfitting was evident in the Z-Standard statistics. Differential item functioning results indicated good performance at an item level for the overall measure; however, contrary to expectation, an OD diagnosis presented only with marginal DIF. The dimensionality of the DHI showed two dimensions in contrast to the three dimensions suggested by the original authors. Conclusions: The DHI failed to reproduce the original three subscales. Caution is needed using the DHI subscales; only the DHI total score should be used. A redevelopment of the DHI is needed; however, given the complexities involved in addressing these issues, the development of a new measure that ensures good content validity may be preferred.