Better assessment of physical function: item improvement is neglected but essential

INTRODUCTION: Physical function is a key component of patient-reported outcome (PRO) assessment in rheumatology. Modern psychometric methods, such as Item Response Theory (IRT) and Computerized Adaptive Testing, can materially improve measurement precision at the item level. We present the qualitative and quantitative item-evaluation process for developing the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function item bank. METHODS: The process was stepwise: we searched extensively to identify extant Physical Function items and then classified and selectively reduced the item pool. We evaluated retained items for content, clarity, relevance and comprehension, reading level, and translation ease by experts and patient surveys, focus groups, and cognitive interviews. We then assessed items by using classic test theory and IRT, used confirmatory factor analyses to estimate item parameters, and graded response modeling for parameter estimation. We retained the 20 Legacy (original) Health Assessment Questionnaire Disability Index (HAQ-DI) and the 10 SF-36\u27s PF-10 items for comparison. Subjects were from rheumatoid arthritis, osteoarthritis, and healthy aging cohorts (n = 1,100) and a national Internet sample of 21,133 subjects. RESULTS: We identified 1,860 items. After qualitative and quantitative evaluation, 124 newly developed PROMIS items composed the PROMIS item bank, which included revised Legacy items with good fit that met IRT model assumptions. Results showed that the clearest and best-understood items were simple, in the present tense, and straightforward. Basic tasks (like dressing) were more relevant and important versus complex ones (like dancing). Revised HAQ-DI and PF-10 items with five response options had higher item-information content than did comparable original Legacy items with fewer response options. IRT analyses showed that the Physical Function domain satisfied general criteria for unidimensionality with one-, two-, three-, and four-factor models having comparable model fits. Correlations between factors in the test data sets were \u3e 0.90. CONCLUSIONS: Item improvement must underlie attempts to improve outcome assessment. The clear, personally important and relevant, ability-framed items in the PROMIS Physical Function item bank perform well in PRO assessment. They will benefit from further study and application in a wider variety of rheumatic diseases in diverse clinical groups, including those at the extremes of physical functioning, and in different administration modes

A longitudinal evaluation of the Center for Epidemiologic Studies-Depression scale (CES-D) in a Rheumatoid Arthritis Population using Rasch Analysis

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Development and Validation of the Computerised Adaptive Beat Alignment Test (CA-BAT)

Beat perception is increasingly being recognised as a fundamental musical ability. A number of psychometric instruments have been developed to assess this ability, but these tests do not take advantage of modern psychometric techniques, and rarely receive systematic validation. The present research addresses this gap in the literature by developing and validating a new test, the Computerised Adaptive Beat Alignment Test (CA-BAT), a variant of the Beat Alignment Test (BAT) that leverages recent advances in psychometric theory, including item response theory, adaptive testing, and automatic item generation. The test is constructed and validated in four empirical studies. The results support the reliability and validity of the CA-BAT for laboratory testing, but suggest that the test is not well-suited to online testing, owing to its reliance on fne perceptual discrimination

On environment difficulty and discriminating power

The final publication is available at Springer via http://dx.doi.org/10.1007/s10458-014-9257-1This paper presents a way to estimate the difficulty and discriminating power of any task instance. We focus on a very general setting for tasks: interactive (possibly multiagent) environments where an agent acts upon observations and rewards. Instead of analysing the complexity of the environment, the state space or the actions that are performed by the agent, we analyse the performance of a population of agent policies against the task, leading to a distribution that is examined in terms of policy complexity. This distribution is then sliced by the algorithmic complexity of the policy and analysed through several diagrams and indicators. The notion of environment response curve is also introduced, by inverting the performance results into an ability scale. We apply all these concepts, diagrams and indicators to two illustrative problems: a class of agent-populated elementary cellular automata, showing how the difficulty and discriminating power may vary for several environments, and a multiagent system, where agents can become predators or preys, and may need to coordinate. Finally, we discuss how these tools can be applied to characterise (interactive) tasks and (multi-agent) environments. These characterisations can then be used to get more insight about agent performance and to facilitate the development of adaptive tests for the evaluation of agent abilities.I thank the reviewers for their comments, especially those aiming at a clearer connection with the field of multi-agent systems and the suggestion of better approximations for the calculation of the response curves. The implementation of the elementary cellular automata used in the environments is based on the library 'CellularAutomaton' by John Hughes for R [58]. 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Use of NON-PARAMETRIC Item Response Theory to develop a shortened version of the Positive and Negative Syndrome Scale (PANSS)

<p>Abstract</p> <p>Background</p> <p>Nonparametric item response theory (IRT) was used to examine (a) the performance of the 30 Positive and Negative Syndrome Scale (PANSS) items and their options ((levels of severity), (b) the effectiveness of various subscales to discriminate among differences in symptom severity, and (c) the development of an abbreviated PANSS (Mini-PANSS) based on IRT and a method to link scores to the original PANSS.</p> <p>Methods</p> <p>Baseline PANSS scores from 7,187 patients with Schizophrenia or Schizoaffective disorder who were enrolled between 1995 and 2005 in psychopharmacology trials were obtained. Option characteristic curves (OCCs) and Item Characteristic Curves (ICCs) were constructed to examine the probability of rating each of seven options within each of 30 PANSS items as a function of subscale severity, and summed-score linking was applied to items selected for the Mini-PANSS.</p> <p>Results</p> <p>The majority of items forming the Positive and Negative subscales (i.e. 19 items) performed very well and discriminate better along symptom severity compared to the General Psychopathology subscale. Six of the seven Positive Symptom items, six of the seven Negative Symptom items, and seven out of the 16 General Psychopathology items were retained for inclusion in the Mini-PANSS. Summed score linking and linear interpolation was able to produce a translation table for comparing total subscale scores of the Mini-PANSS to total subscale scores on the original PANSS. Results show scores on the subscales of the Mini-PANSS can be linked to scores on the original PANSS subscales, with very little bias.</p> <p>Conclusions</p> <p>The study demonstrated the utility of non-parametric IRT in examining the item properties of the PANSS and to allow selection of items for an abbreviated PANSS scale. The comparisons between the 30-item PANSS and the Mini-PANSS revealed that the shorter version is comparable to the 30-item PANSS, but when applying IRT, the Mini-PANSS is also a good indicator of illness severity.</p

KIDMAP, a web based system for gathering patients' feedback on their doctors

<p>Abstract</p> <p>Background</p> <p>The gathering of feedback on doctors from patients after consultations is an important part of patient involvement and participation. This study first assesses the 23-item Patient Feedback Questionnaire (PFQ) designed by the Picker Institute, Europe, to determine whether these items form a single latent trait. Then, an Internet module with visual representation is developed to gather patient views about their doctors; this program then distributes the individualized results by email.</p> <p>Methods</p> <p>A total of 450 patients were randomly recruited from a 1300-bed-size medical center in Taiwan. The Rasch rating scale model was used to examine the data-fit. Differential item functioning (DIF) analysis was conducted to verify construct equivalence across the groups. An Internet module with visual representation was developed to provide doctors with the patient's online feedback.</p> <p>Results</p> <p>Twenty-one of the 23 items met the model's expectation, namely that they constitute a single construct. The test reliability was 0.94. DIF was found between ages and different kinds of disease, but not between genders and education levels. The visual approach of the KIDMAP module on the WWW seemed to be an effective approach to the assessment of patient feedback in a clinical setting.</p> <p>Conclusion</p> <p>The revised 21-item PFQ measures a single construct. Our work supports the hypothesis that the revised PFQ online version is both valid and reliable, and that the KIDMAP module is good at its designated task. Further research is needed to confirm data congruence for patients with chronic diseases.</p

Differential Item Functioning on Antisocial Behavior Scale Items for Adolescents and Young Adults from Single-Parent and Two-Parent Families

We investigated measurement equivalence in two antisocial behavior scales (i.e., one scale for adolescents and a second scale for young adults) by examining differential item functioning (DIF) for respondents from single-parent (n = 109) and two-parent families (n = 447). Even though one item in the scale for adolescents and two items in the scale for young adults showed significant DIF, the two scales exhibited non-significant differential test functioning (DTF). Both uniform and nonuniform DIF were investigated and examples of each type were identified. Specifically, uniform DIF was exhibited in the adolescent scale whereas nonuniform DIF was shown in the young adult scale. Implications of DIF results for assessment of antisocial behavior, along with strengths and limitations of the study, are discussed