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Rasch analysis of the modified version of the postural assessment scale for stroke patients: postural stroke study in Gothenburg (POSTGOT).

ABSTRACT: The modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) is a new ordinal outcome measurement designed to assess postural control in patients with stroke. Before implementation of SwePASS into the clinical setting, it is necessary to know its measurement properties. Thus, the aim of the study was to evaluate the measurement properties of the SwePASS.Rasch analysis, based on data of 150 SwePASS assessments was made the first week after stroke onset. The measurement properties referred to were unidimensionality, local independence, invariance, category function, targeting of persons and items and the reliability.The initial analysis showed disordered thresholds in four items. After adjustment of the scoring categories, this was resolved. However, analyses of local dependency revealed correlations between two of the items. These two items were collapsed into one. After adjustments, the person separation index that acts as an indicator of the whole model fit was 0.96. The adjusted SwePASS is a global scale that works the same way regardless of gender, age and location of stroke lesion. Overall, the population had better postural control than was targeted with the items in the scale.Rasch analysis of the adjusted SwePASS showed that the scale was unidimensional. In SwePASS, equal capacity in postural control provides the same response to an individual item in patients with stroke, regardless of gender, age and location of stroke lesion. Regarding clinical implications, before introducing SwePASS in clinical routine and to confirm the results, further research including a larger sample with poorer postural control is suggested.

SUBMITTER: Persson CU

PROVIDER: S-EPMC4069346 | biostudies-other | 2014 Jun

REPOSITORIES: biostudies-other

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Rasch analysis of the modified version of the postural assessment scale for stroke patients: postural stroke study in Gothenburg (POSTGOT).

Persson Carina U CU Sunnerhagen Katharina S KS Lundgren-Nilsson Asa A

BMC neurology 20140619

<h4>Background</h4>The modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) is a new ordinal outcome measurement designed to assess postural control in patients with stroke. Before implementation of SwePASS into the clinical setting, it is necessary to know its measurement properties. Thus, the aim of the study was to evaluate the measurement properties of the SwePASS.<h4>Methods</h4>Rasch analysis, based on data of 150 SwePASS assessments was made the first week after ...[more]

PMID: 24946807

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Project description:BACKGROUND: A modified version of Postural Assessment Scale for Stroke Patients (PASS) was created with some changes in the description of the items and clarifications in the manual (e.g. much help was defined as support from 2 persons). The aim of this validation study was to assess intrarater and interrater reliability using this modified version of PASS, at a stroke unit, for patients in the acute phase after their first event of stroke. METHODS: In the intrarater reliability study 114 patients and in the interrater reliability study 15 patients were examined twice with the test within one to 24 hours in the first week after stroke. Spearman's rank correlation, Kappa coefficients, Percentage Agreement and the newer rank-invariant methods; Relative Position, Relative Concentration and Relative rank Variance were used for the statistical analysis. RESULTS: For the intrarater reliability Spearman's rank correlations were 0.88-0.98 and k were 0.70-0.93 for the individual items. Small, statistically significant, differences were found for two items regarding Relative Position and for one item regarding Relative Concentration. There was no Relative rank Variance for any single item.For the interrater reliability, Spearman's rank correlations were 0.77-0.99 for individual items. For some items there was a possible, even if not proved, reliability problem regarding Relative Position and Relative Concentration. There was no Relative rank Variance for the single items, except for a small Relative rank Variance for one item. CONCLUSIONS: The high intrarater and interrater reliability shown for the modified Postural Assessment Scale for Stroke Patients, the Swedish version of Postural Assessment Scale for Stroke Patients, with traditional and newer statistical analyses, particularly for assessments performed by the same rater, support the use of the Swedish version of Postural Assessment Scale for Stroke Patients, in the acute stage after stroke both in clinical and research settings. In addition, the Swedish version of Postural Assessment Scale for Stroke Patients was easy to apply and fast to administer in clinic.

Project description:BACKGROUND:Fatigue is a common symptom associated with a wide range of diseases and needs to be more thoroughly studied. To minimise patient burden and to enhance response rates in research studies, patient-reported outcome measures (PROM) need to be as short as possible, without sacrificing reliability and validity. It is also important to have a generic measure that can be used for comparisons across different patient populations. Thus, the aim of this secondary analysis was to evaluate the psychometric properties of the Norwegian 5-item version of the Lee Fatigue Scale (LFS) in two distinct patient populations. METHODS:The sample was obtained from two different Norwegian studies and included patients 4-6 weeks after stroke (n = 322) and patients with osteoarthritis on a waiting list for total knee arthroplasty (n = 203). Fatigue severity was rated by five items from the Norwegian version of the LFS, rating each item on a numeric rating scale from 1 to 10. Rasch analysis was used to evaluate the psychometric properties of the 5-item scale across the two patient samples. RESULTS:Three of the five LFS items ("tired", "fatigued" and "worn out") showed acceptable internal scale validity as they met the set criterion for goodness-of-fit after removal of two items with unacceptable goodness-of-fit to the Rasch model. The 3-item LFS explained 81.6% of the variance, demonstrated acceptable unidimensionality, could separate the fatigue responses into three distinct severity groups and had no differential functioning with regard to disease group. The 3-item version of the LFS had a higher separation index and better internal consistency reliability than the 5-item version. CONCLUSIONS:A 3-item version of the LFS demonstrated acceptable psychometric properties in two distinct samples of patients, suggesting it may be useful as a brief generic measure of fatigue severity. TRIAL REGISTRATION:Clinicaltrials.gov: NCT02338869; registered 10/04/2014 (stroke study).

Project description:BACKGROUND:Person-centred care is the bedrock of modern dementia services, yet the evidence-base to support its implementation is not firmly established. Research is hindered by a need for more robust measurement instruments. The 14-item Person-Centred Climate Questionnaire - Staff version (PCQ-S) is one of the most established scales and has promising measurement properties. However, its construction under classical test theory methods leaves question marks over its rigour and the need for evaluation under more modern testing procedures. METHODS:The PCQ-S was self-completed by nurses and other care staff working across nursing homes in 35 Swedish municipalities in 2013/14. A Rasch analysis was undertaken in RUMM2030 using a partial credit model suited to the Likert-type items. Three subscales of the PCQ-S were evaluated against common thresholds for overall fit to the Rasch model; ordering of category thresholds; unidimensionality; local dependency; targeting; and Differential Item Functioning. Three subscales were evaluated separately as unidimensional models and then combined as subtests into a single measure. Due to large number of respondents (n?=?4381), two random sub-samples were drawn, with a satisfactory model established in the first ('evaluation') and confirmed in the second ('validation'). Final item locations and a table converting raw scores to Rasch-transformed values were created using the full sample. RESULTS:All three subscales had disordered thresholds for some items, which were resolved by collapsing categories. The three subscales fit the assumptions of the Rasch model after the removal of two items, except for subscale 3, where there was evidence of local dependence between two items. By forming subtests, the 3 subscales were combined into a single Rasch model which had satisfactory fit statistics. The Rasch form of the instrument (PCQ-S-R) had an adequate but modest Person Separation Index (<?0.80) and some evidence of mistargeting due to a low number of 'difficult-to-endorse' items. CONCLUSIONS:The PCQ-S-R has 12 items and can be used as a unidimensional scale with interval level properties, using the nomogram presented within this paper. The scale is reliable but has some inefficiencies due to too few high-end thresholds inhibiting discrimination amongst populations who already perceive that person-centred care is very good in their environment.

Project description:OBJECTIVES:This investigation expected to validate the psychometric properties of the modified seven-item Kessler psychological distress scale (K7) for measuring psychological distress in healthy rural population of Bangladesh. DESIGN:Cross-sectional study. SETTING:Narail district, Bangladesh. PARTICIPANTS:A random sample of 300 adults of age 18-90 years were recruited. Face-to-face interviews were conducted between July and August 2018 using an Android phone installed with a mobile data collection application known as CommCare. OUTCOME MEASURE:Validation of the K7 was the major outcome. Sociodemographic factors were measured to assess for Differential Item Functioning to check if the tool functions equally in different factors. Rasch analysis was carried out for the validation of the K7 scale in the healthy rural population of Bangladesh. RUMM2030 was used for the analyses. RESULTS:Results showed good overall fit, as indicated by a non-significant item-trait interaction (?2=44.54, df=28, p=0.0245) compared with a Bonferroni adjusted p value of 0.007. Both item fit (mean=0.30, SD 1.22) and person fit residuals (mean=-0.18, SD 0.85) showed perfect fit. Reliability was very good as indicated by a Person Separation Index=0.85?and Cronbach's alpha=0.89. All individual items were ordered thresholds. The K7 scale showed adequate reliability, unidimensionality and was free from local dependency. The K7 scale also showed similar functioning for adults and older adults, males and females, no education and any level of education, and at least some financial instability versus no financial instability. CONCLUSIONS:Validation of K7 scale confirmed that the tool is suitable for measuring psychological distress among the rural Bangladeshi population. Further research should validate the K7 scale in different rural settings in Bangladesh to determine a valid cut-off score for assessment of severity levels of psychological distress. The K7 scale should also be tested in other developing countries where sociodemographic characteristics are similar to those of Bangladesh.

Dataset Information

Rasch analysis of the modified version of the postural assessment scale for stroke patients: postural stroke study in Gothenburg (POSTGOT).

Publications

Rasch analysis of the modified version of the postural assessment scale for stroke patients: postural stroke study in Gothenburg (POSTGOT).

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