Rasch analysis for development and reduction of Symptom Questionnaire for Visual Dysfunctions (SQVD)

Analyzing display photometric features through time-dependent dynamics of accommodative responses and ocular imaging quality

To optimize screen quality for a better and healthier visual experience, it is essential to understand how photometric parameters impact ocular physiological parameters. However, the relationship between these photometric and physiological parameters has still not been clearly defined. In this study, time series data of accommodative response and ocular imaging quality at various time points during screen viewing were analyzed, examining different screen photometric parameters. The concept of "tolerance duration" based on these time series curves was introduced. The findings indicate that accommodative response is sensitive to screen brightness, while ocular imaging quality is affected by spectral power distribution. The mathematic models of time-dependent dynamics for both accommodative response and ocular imaging quality were developed, consisting of positive and negative forces. The accommodative response displayed an exponential decay and linear increase pattern, whereas the ocular imaging quality corresponded more closely to sigmoid functions. This innovative model could broaden the understanding of ocular physiological changes during screen use. Additionally, it may offer useful insights for optimizing screen photometric parameters and assist in monitoring ocular responses in clinical research.

Development and Validation of a Short Version (PAIC6) of the Pain Assessment in Impaired Cognition Scale

BACKGROUND

Observer pain scales are commonly used to assess pain in individuals with impaired cognition. However, nursing staff have highlighted that extremely tight time schedules and increasing workload demands prevent regular use. With the development of a short version of the Pain Assessment in Impaired Cognition (PAIC15), we aimed to reduce implementation barriers in everyday clinical practice.

METHODS

We developed a new 6-item short version (PAIC6) in a first sample (N = 59) and validated its psychometric properties in a second sample (N = 250) of older individuals with cognitive impairments. The item reduction and evaluation involved four steps. First, we used Sample 1 to exclude items based on item quality statistics (e.g., difficulty, reliability). Second, the Partial Credit Model (PCM) was utilised for further reduction using again Sample 1. Third, an expert panel evaluated the preceding steps and suggested a draft short version with six items (PAIC6). Fourth, psychometric properties of the short version were evaluated in the independent Sample 2. Thereafter, the final short version was approved.

RESULTS

The new PAIC6 showed a high correlation with the total scale PAIC15 (r = 0.870), good reliability (Cronbach's α = 0.684), and high convergent construct validity, as observed by a high correlation with the established Pain Assessment in Advanced Dementia (r = 0.602).

CONCLUSIONS

Overall, we developed a valid, reliable, and clinically valuable PAIC6 that allows a more time-efficient pain assessment, by reducing the assessment time from 5 min to approximately 2 min (60% time saving).

SIGNIFICANCE

Observer pain scales are commonly used to assess pain in individuals with impaired cognition. However, nursing staff have highlighted that extremely tight time schedules and increasing workload demands prevent regular use. To address this, we developed PAIC6, a short version of the Pain Assessment in Impaired Cognition 15 (PAIC15). PAIC6 includes six items and takes 2 min for completion after training, realising a 60%-time reduction compared to the original scale while keeping the psychometric quality high.

Validation of the Ocular Pain Assessment Survey Instrument With Rasch Analysis

Purpose

The Ocular Pain Assessment Survey (OPAS) has been used to quantify chronic ocular pain and quality of life (QOL). We aim to investigate the psychometric properties of individual OPAS items with the Rasch analysis in an Asian population of dry eye disease and neuropathic corneal pain (NCP).

Methods

Question responses were obtained from 196 patients; 138 with dry eye disease (DED) and 58 with NCP, at the Singapore National Eye Centre. Item hierarchy, item fit statistics, item separation, reliability indices, and Yen's Q3 values were calculated.

Results

Individual dimensions that quantify eye pain levels in the past 24 hours and QOL showed good discriminative ability according to their person separation index values. However, individual dimensions that measured eye pain in the past 2 weeks, non-eye pain, as well as aggravating and associated factors showed suboptimal person separation index values. Significant correlations were found between the individual item pairs of the aggravating factors dimension as well as between some of the items in the QOL and associated factors dimensions.

Conclusions

Two dimensions of the OPAS questionnaire were validated with the Rasch analysis. Based on these findings, we shorten the number of questions in some dimensions to improve the performance of the tool in similar Asian populations.

Translational Relevance

Our study provides insights to improve the existing OPAS for real-world clinical applications and clinical trials.

Is the convergence insufficiency symptom survey applicable to elderly individuals?

BACKGROUND

The psychometric properties of the Convergence Insufficiency Symptom Survey (CISS) have been previously determined across the younger adult population. This study investigated the psychometric properties of the CISS in presbyopic adults via classical and Rasch analysis.

METHODS

A total of 100 presbyopic individuals (40-60 years) were selected with far and near acuity of 20/20 with their habitual spectacles; 50 had convergence insufficiency and 50 had normal binocular vision. Refraction, cover test, near point of convergence, and positive fusional ranges were examined. The Persian translated CISS was administered twice, once in the first session and 7 to 14 days later. Classical and Rasch analyses were conducted.

RESULTS

The mean ages and gender ratios in the CI group and normal group were 49.70 ± 5.96 and 49.82 ± 5.64 years with a 50% female distribution among individuals. The mean CISS scores for presbyopes with CI and normal groups were 19.24 ± 5.33 and 13.26 ± 3.53 respectively (p < 0.001). Effective discrimination was achieved with a score greater than 15, yielding a sensitivity of 72%, a specificity of 69%, and an Area Under the Curve (AUC) of 0.813. For internal consistency, Cronbach's α coefficient was 0.82. For test-retest reliability in CISS scores, ICC was 0.91 (confidence interval 0.88-0.93) with the 95% limits of agreement in CI group being - 3.91 to 2.59. The Rasch analysis demonstrated a satisfactory model fit, as all items had infit and outfit mean square values ranging between 0.6 and 1.4. The measurement precision was good, with a person separation value of 2.30. Additionally, the first contrast eigenvalue of 2.34 and a raw variance of less than 50% indicated multidimensionality. The CI group reported headaches (item 3) more frequently than the normal binocular vision group did. However, eye discomfort scores (item 10) were similar for both groups.

CONCLUSIONS

The CISS is a valid and reliable tool for assessing the symptoms in presbyopic adults. However, due to this survey's multidimensionality, we recommend additional objective examinations in presbyopic adults with CI.

Validation of the uncertainty stress scale-high-risk pregnancy - Chinese brief version: Rasch analysis

BACKGROUND

High-risk pregnancy leads to uncertainty and stress in pregnant women due to the threatened of mother and fetus health. The Uncertainty Stress Scale High-Risk Pregnancy Version, a 54-item Chinese version (USS-HRPV-C), has been widely used to assess the uncertainty and stress that women experience during pregnancy. However, the length of the scale may result in a burden for respondents. Thus, a brief version of the USS-HRPV-C is needed for a concise and vigorous assessment. The aim of this study was to shorten the USS-HRPV-C and validate the brief version.

METHODS

This study used a cross-sectional design. A convenience sample of 200 women with high-risk pregnancies completed the 54-item USS-HRPV- C. Confirmatory factor analysis (CFA) and Rasch model to examine the construct validity of the short version of the USS-HRPV-C. Rasch analysis was used with a stepwise approach to select items with better goodness-of-fit and no differential item functioning (DIF). Additionally, Cronbachs' α and Pearson correlations to evaluate the internal consistency of the original and brief versions. Test analysis modules (TAM) and Lavaan packages in R were used for data analyses.

RESULTS

The results of CFA supported a two-factor structure of the HRPV-C. Using the Rasch analysis, we reduced the USS-HRPV-C scale from 54 to 17 items. The selected 17 items were robust without displaying differential item functioning. Further, the 17-item short version exhibited satisfactory fit statistics that infit and outfit mean square ranged between 0.71 and 1.35, respectively. Internal consistency of Cronbach's α for the short version of the USS-HRPV-C scale ranged was 0.90 and 0.92 for the subscales of uncertainty and stress respectively. Both subscales of the brief version were significantly related to the original version of USS-HRPV-C.

CONCLUSIONS

This study developed a 17-item brief version of the USS-HRPV-C scale, which has demonstrated its satisfactory psychometric properties. Healthcare providers can use the validated brief version of the USS-HRPV-C to proficiently assess women's psychosocial stress and uncertainty during pregnancy.

The Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS): an Italian validation using confirmatory factor analysis and Rasch analysis

The present study examined the psychometric properties of the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). A total of 742 Italian participants (84.6% female), with a mean age of 33.08 years (SD = 12.44) took part in a cross-sectional survey study. Confirmatory factor analysis and Rasch analysis were used to examine the psychometric properties. The CFA showed that the SWEMWBS had a unidimensional structure with robust psychometric properties and showed good internal consistencies (Cronbach's alpha 0.88; McDonald's omega 0.91). Overall, most items showed no substantial differential item functioning in the Rasch analysis, except for Item 7, indicating that female participants reported more difficulty with this item than the male participants. The SWEMWBS was positively associated with life satisfaction and negativity associated with general psychological distress (i.e., anxiety, stress, and depression). In sum, the SWEMWBS showed robust psychometric properties capable of assessing positive aspects of mental health and well-being among Italian-speaking adults.

Effects of colour and scene dynamism on visual fatigue in animated films

Animated films are highly popular in society, particularly among children and adolescents. During film production, selecting an adequate colour palette and scene dynamism is crucial for creating a visual impact on the audience. However, the influence of visual aesthetics, such as colour and scene dynamism on visual fatigue remains unexplored. In the present study, visual fatigue was assessed and compared in 30 young participants after viewing two popular films: Spider-Man: Across the Spider-Verse, an active, fast-paced film, and My Neighbour Totoro, a more relaxed film. Both films were viewed twice, once with the original colour palette and once in greyscale. Watching Spider-Man film induced a greater degree of visual fatigue than My Neighbour Totoro in two subjective questionnaires evaluating visual fatigue, and in the vergence facility and binocular accommodative facility tests. Moreover, important differences in the visual dynamics and colour aspects between both films were found. These results demonstrate that the high-paced and high-colour aspects of films directly affect visual fatigue. Future animated film producers should consider these factors that are relevant to their audiences.

Development and Psychometric Assessment of a Chinese Version of the Ultra-Low Vision Visual Functioning Questionnaire-50

Purpose

To develop a short form of Chinese ULV-VFQ-50 based on the ULV-VFQ-150 and compare the psychometrical properties of the two questionnaires.

Methods

We selected candidate items from the ULV-VFQ-150, considering the item response among ultra-low vision (ULV) participants, the even distribution of item measures, visual aspects, and visual domains, to construct a 50-item ULV-VFQ-50 questionnaire. Then, ULV participants were recruited to evaluate its psychometric characteristics by using Rasch analysis.

Results

In total, 79 out of 79 completed questionnaires of ULV-VFQ-50 were collected, of which 11 filled questionnaires were excluded because the participants' vision did not meet the inclusion criteria. Thus 68 valid questionnaires were analyzed (valid response rate 91.9%). The average age of the eligible responders was 45.0 years (standard deviation [SD] = 16.7), with 42.6% females (29/68). As per Rasch analysis, the person measures ranged from -1.74 to 4.91 logits, and the item measures ranged from -1.56 to 1.15 logits. The mean value of item difficulty was 0.00 logits, whereas the mean value of personnel distribution was -0.35 logits. The item reliability was 0.95, and the person reliability was 0.98. The items conform to unidimensionality as indicated by principal component analysis of the residuals, which showed that the first principal component unexplained only 5.5% of the total variance, and each component after that unexplained even less.

Conclusions

The Chinese ULV-VFQ-50 exhibits excellent psychometric properties. The short form of Chinese ULV-VFQ, with fewer items and less administration time is better suited for clinical practice and research settings.

Translational Relevance

The Chinese version of ULV-VFQ-50 is a reliable assessment of the visual function for people with ULV in China.

Chinese version of the Death Anxiety Beliefs and Behaviours Scale: Psychometric properties based on CTT and IRT

OBJECTIVES

The Death Anxiety Beliefs and Behaviour Scale (DABBS) is a unique tool designed to assess the detrimental beliefs and avoidant behaviors linked to death anxiety. This study aimed to adapt the DABBS into Chinese and verify its psychometric characteristics within a community-dwelling older adult population.

METHODS

This study used a cross-sectional design and translated the DABBS into Chinese. The psychometric properties of 437 community-dwelling older persons were assessed using the Classical Test Theory (CTT) and Item Response Theory (IRT).

RESULTS

The DABBS consisted of affect, beliefs, and behaviours, with 18 entries in 3 dimensions. The I-CVI of the DABBS ranged from 0.857 to 1.000, and the S-CVI was 0.968; Cronbach's alpha of 0.905. Rasch analysis results showed that the 3 dimensions of the scale possessed good unidimensionality, and the entries were well-fitted to the dimensions in which they were located; each entry Infit MNSQ and Outfit MNSQ were in the range of 0.50 to 1.50; the analysis of the functional differences of items in different characteristic subgroups (gender) showed that the absolute value of DIF Contrast was <0.50. The results of the Wright map showed that the ability of the participants was normally distributed, and the difficulty of the scale's entries was adapted to the average ability level of older adults.

CONCLUSIONS

The present data indicate that the revised DABBS is a valid and reliable tool for assessing affect, beliefs, and behaviors associated with death anxiety in community-dwelling older individuals.

Adaptation and psychometric testing of the Turkish evaluation of daily activity questionnaire in people with rheumatoid arthritis

PURPOSE

The aims were to translate the Evaluation of Daily Activity Questionnaire (EDAQ) into Turkish, then test validity and reliability in people with rheumatoid arthritis (RA) in Turkey.

MATERIAL AND METHODS

Phase 1: The EDAQ was forward and backward translated, culturally adapted following cognitive debriefing interviews with participants with RA (n = 10) and finalized by an expert committee. Phase 2: Participants (n = 215) completed a questionnaire including the EDAQ, Health Assessment Questionnaire (HAQ), and Short-Form 36 v1 (SF-36v1). Two weeks later, the EDAQ was again completed for test-retest reliability (n = 82:38%). Internal construct validity was assessed using Rasch analysis. Internal consistency, concurrent validity, and test-retest reliability were assessed.

RESULTS

Following cultural adaptation, one item was removed, and examples increased or changed. Cronbach's α values were 0.71 - 0.93 for all EDAQ domains, that is, acceptable to good. The EDAQ met Rasch model requirements for fit (excellent construct validity: p > 0.05). Concurrent validity was moderate to strong for most EDAQ domains with HAQ (rs 0.49-0.81) and SF-36-v1 Physical Function (rs 0.42-0.70). There was excellent test-retest reliability for all domains (ICC (2,1): 0.95-1.00).

CONCLUSION

The Turkish EDAQ is a valid, reliable measure of daily activity ability for use in practice and research with Turkish speakers with RA.

Linguistic and cultural validation of symptom questionnaire for visual dysfunctions (SQVD) for psychometric analysis in the Chinese context

The Spanish scale symptom questionnaire for visual dysfunctions (SQVD) was sinicized and tested for reliability and validity in the Chinese context, employing both classical measurement theory and item response theory. A meticulous translation was conducted using the modified Brislin translation model, with input from experts for cross-cultural debugging and in-depth review. Following a pre-survey study, the Chinese version of the SQVD was finalized. A convenience sampling method was used to select 270 patients from the target group and 252 valid questionnaires were successfully collected. The Rasch model was employed to assess response category functionality, fit statistics, unidimensionality, person and item reliability, separation, targeting, and differential item functioning. Classical test theory was applied to evaluate internal consistency and retest reliability, supplemented by correlation analysis. Job characteristic curves were also plotted to assess diagnostic accuracy. The Chinese SQVD conformed to a unidimensional structure with excellent reliability and validity. Person and item reliabilities were 0.85 and 0.99, respectively, indicating, high stability. Person and item separation indices were 2.37 and 11.54, respectively, signifying strong differentiation ability. Retest reliability was 0.917, further emphasizing the stability of the scale. The area under the receiver operating characteristic curve was 0.908 (95% CI: 0.854, 0.962), with a cutoff value of 7.5 and Youden index of 0.733, highlighting the scale's high diagnostic accuracy. The translated and culturally adapted Chinese SQVD demonstrated excellent psychometric properties. With streamlined items, short assessment time, and high efficiency, the scale is a stable and reliable clinical tool for detecting a variety of conditions related to refractive, regulatory, and binocular vision dysfunction.

Rasch validation of the Keratoconus End-Points Assessment Questionnaire in a Spanish population with keratoconus

OBJECTIVE

To carry out a methodologically complete validation of the Spanish version of the Keratoconus End-Points Assessment Questionnaire (KEPAQ) in a Spanish population with keratoconus.

METHODS

Analytical, prospective study, including patients with keratoconus without previous surgical history, in which a measurement of quality of life was performed using the KEPAQ questionnaire, a complete exploration of the anterior pole and a corneal elevation topography with the Galilei G6 topographer. The evaluation of the psychometric characteristics of the scale in the studied population was carried out using Rasch modeling.

RESULTS

A total of 140 patients with keratoconus were included, with a median age of 26.0 years, the majority (57.6%) being men. For the KEPAQ-E subscale, the median score was 69.3, with a reliability of 0.85 and an eigenvalue of the first contrast of 2.34. For the KEPAQ-F, the median score was 56.4, with a reliability of 0.88 and an eigenvalue of 2.00. All infit and outfit parameters were within normal limits for both subscales. A significant evaluation was found between the evaluations of both subscales (rho = 0.696; p < 0.001). The evaluations of the subscales and various clinical and tomographic characteristics showed a significant classification between them (p value between 0.048 y 0.001).

CONCLUSION

The KEPAQ is a psychometrically robust and valid scale to evaluate quality of life in the Spanish population with keratoconus. This questionnaire can be easily used for both clinical and research aims.

Evaluation and application of a Chinese version symptom questionnaire for visual dysfunctions (CSQVD) in school-age children

Objective

To develop and evaluate a Chinese version of the Symptom Questionnaire for Visual Dysfunctions (CSQVD) to quantify visual dysfunction symptoms in school-age children with various eye diseases, and to explore the relationship between ophthalmological disorders and visual dysfunction symptoms.

Methods

Following standard scale adaptation procedures, the Symptom Questionnaire for Visual Dysfunctions (SQVD) was translated into Chinese (CSQVD). We employed random sampling to survey 198 outpatients aged 7-18 to assess the psychometric properties of the CSQVD. Using the reliable and validated questionnaire, we evaluated the determinants of visual dysfunction symptoms among 406 school-age patients at an eye center. The CSQVD scores were correlated with demographic and clinical variables, including gender, age, eye position, refractive power, and best-corrected visual acuity. Univariate analysis identified potential risk factors, followed by binary logistic regression and multiple linear regression analysis on factors with a P-value <0.05.

Results

The CSQVD scale's critical ratio (CR) values ranged from 6.028 to 10.604. The Cronbach's Alpha coefficient was 0.779, and Spearman-Brown split-half reliability was also 0.779. The I-CVI varied from 0.83 to 1.000, the S-CVI/Ave was 0.857, and the KMO value was 0.821. Multifactorial regression analysis indicated that high myopia (OR ​= ​5.744, 95% CI [1.632, 20.218], P ​= ​0.006) and amblyopia (OR ​= ​9.302, 95% CI [1.878, 46.058], P ​= ​0.006) were significant predictors of CSQVD symptoms. Multiple linear regression analysis showed that BCVA of amblyopic eyes (B ​= ​-5.052, 95% CI [-7.779, 2.325], P ​= ​0.000) and SE power (B ​= ​-0.234, 95% CI [-0.375, 0.205], P ​= ​0.001) significantly affected the CSQVD scale scores.

Conclusions

The Chinese version of the SQVD scale (CSQVD) demonstrates good feasibility, discriminatory power, validity, and reliability in assessing Chinese school-aged children. Furthermore, those who have severe myopia and amblyopia reported more visual dysfunction symptoms.

Assessing the role of visual dysfunctions in the association between visual symptomatology and the use of digital devices

PURPOSE

To evaluate the association between visual symptoms and use of digital devices considering the presence of visual dysfunctions.

METHODS

An optometric examination was conducted in a clinical sample of 346 patients to diagnose any type of visual anomaly. Visual symptoms were collected using the validated SQVD questionnaire. A threshold of 6 hours per day was used to quantify the effects of digital device usage and patients were divided into two groups: under and above of 35 years old. A multivariate logistic regression was employed to investigate the association between digital device use and symptoms, with visual dysfunctions considered as a confounding variable. Crude and the adjusted odds ratio (OR) were calculated for each variable.

RESULTS

57.02 % of the subjects reported visual symptoms, and 65.02% exhibited some form of visual dysfunction. For patients under 35 years old, an association was found between having visual symptoms and digital device use (OR = 2.10, p = 0.01). However, after adjusting for visual dysfunctions, this association disappeared (OR = 1.44, p = 0.27) and the association was instead between symptoms and refractive dysfunction (OR = 6.52, p < 0.001), accommodative (OR = 10.47, p < 0.001), binocular (OR = 6.68, p < 0.001) and accommodative plus binocular dysfunctions (OR = 46.84, p < 0.001). Among patients over 35 years old, no association was found between symptoms and the use of digital devices (OR = 1.27, p = 0.49) but there was an association between symptoms and refractive dysfunction (OR = 3.54, p = 0.001).

CONCLUSIONS

Visual symptoms are not dependent on the duration of digital device use but rather on the presence of any type of visual dysfunction: refractive, accommodative and/or binocular one, which should be diagnosed.

The 6-Item Vision-Related Quality of Life and Limitations Questionnaire: Evaluation of Psychometric Properties

Purpose

We developed the Vision-related Quality of life and Limitations Questionnaire (VQL-6), a screening instrument to signal a need for additional care resulting from reduced vision-related quality of life in patients with chronic ophthalmic diseases. The aim of the present study was to evaluate psychometric properties.

Methods

A Dutch population-based sample of 2032 participants (mean age, 55 ± 19 years) completed the VQL-6 and other questionnaires on vision-related quality of life, executive functioning, attention, mental health, and symptom validity. In addition, we recruited a sample of 208 ophthalmic patients (mean age, 72 ± 12 years) and 98 age and gender similar controls (mean age, 69 ± 11 years) who completed the VQL-6 and the National Eye Institute Visual Function Questionnaire-25. We studied the factor structure, internal consistency, convergent and divergent validity, and known-groups validity.

Results

For the factor analyses, the population-based sample was split randomly in two subsamples. Exploratory factor analysis on the first subsample suggested a two-factor model (visual limitations and general health and quality of life), which was supported by confirmatory factor analyses on the second subsample, and on the patients. The VQL-6 demonstrated good internal consistency within each factor (0.78-0.89), sufficient convergent (r2= 55%) and divergent validity (r2 = 11%-24%), and good known-groups validity (Cohen's r = 0.57; P < 0.001).

Conclusions

The VQL-6 has a robust two-factor structure and seems to be a valid tool to assess vision-related quality of life. Additional validation is needed in patients with chronic ophthalmic diseases.

Translational Relevance

Future research is needed to determine if the VQL-6 can be used to identify patients with chronic ophthalmic diseases who are in need of additional care.

Development of a new 17-item Asthenopia Survey Questionnaire using Rasch analysis

AIM

To develop the 17-item Asthenopia Survey Questionnaire (ASQ)-17 by Rasch analysis, and to generate a predictiveness score.

METHODS

Totally 739 participants were recruited and 680 were involved in the result analysis in this prospective, cross-sectional study. Three rounds of Rasch analysis were used to analyze the psychometric characteristics of items and options.

RESULTS

Phase 1 assessed the original ASQ-19, adjusted the item scoring mode to a four-point Likert response rating scale and combined the 18th and 19th items into a new item. Phase 2 deleted the 11th item. Phases 3 and 4 assessed the new ASQ-17. All the evaluation indexes of ASQ-17 were acceptable. The Infit and Outfit MnSq values of items were 0.67-1.48, the variance explained by the principal component and the unexplained variance explained by the first contrast were 53.90%-59.40% and 1.50-1.80 in three dimensions. The curve peaks of scores in each dimension were separated and in the same order. The PSR and PSI values were 2.80 and 0.89, respectively. The mean scores of dimensions A (9.5±4.1 vs 3.5±3.2), B (7.3±3.3 vs 2.5±2.7), C (4.3±2.2 vs 1.4±2.0) and total (21.1±8.1 vs 7.4±7.0) in asthenopia participants were significantly higher than those without asthenopia (all P<0.001). The area under the curve in two groups was 0.899 (P<0.001). Youden's index was up to the maximum value of 0.784 when the cut-off value was 12.5.

CONCLUSION

ASQ-17 has stronger option sorting and suitability than ASQ-19. It is an effective assessment tool for asthenopia with an optimal cut-off threshold value of 12.5, which is suitable for diagnosis and curative effect evaluation.

Psychometric validation of the Cognitive Abilities Screening Instrument using Rasch analysis in people with dementia

This study aimed to examine unidimensionality of the Cognitive Abilities Screening Instrument (CASI) using Rasch analysis and estimate Rasch person reliability in people with dementia. CASI data of people with dementia was collected from medical records of one general hospital in northern Taiwan. A total of 506 people with dementia were recruited from the Department of Neurology. The confirmatory factor analysis was first conducted to verify the fitness of one-factor model of the CASI. Unidimensionality was confirmed through 2 assumptions: the infit and outfit mean square were 0.5 to 1.5, and residual variance of the first principal component in principal component analysis was ≤20%. Rasch person reliability was estimated after undimensionality was supported. The results of one-factor model had shown that the Comparative Fit Index = 0.99, Tucker Lewis Index = 0.99, Root Means Square Error of Approximation = 0.015, and Standardized Root Mean Square Residual = 0.067, representing a good fit to the model. Both the infit and outfit mean square were ranged 0.87 to 1.37 and 0.86 to 1.42, respectively, and low residual variance of the first principal component (12.3%). Rasch person reliability result of 0.58 was satisfactory. The person-item map indicated the difference between item difficulty and person ability was within the acceptable limits (0.22 logits). Differential Item Function was found between -0.48 to 0.44 logits for gender, indicating the CASI functioned similarly for both genders. The 46 items of the CASI showed a unidimensional construct. The CASI had been demonstrated as a valid and reliable screening tool for assessing overall cognitive function in people with dementia, capturing their cognitive functions effectively.

The development and validation of the Chinese safety climate scale using the item-response theory approach

Introduction

To develop a valid and practical tool to measure the safety climate in China, and further raise awareness of it in Chinese industries, we developed the Chinese safety climate scale (including two subscales at the levels of organization and group separately) based on the work of Huang et al. in 2017.

Methods

A descriptive survey with the convenience sampling method was conducted in Shanghai Disney Resort, China. A sample of 1,570 employees was involved in the final data analyses. The item response theory (IRT) analyses with graded response models were conducted using.

Results

The unidimensionality and local independence assumption were held. The Cronbach's α of organization- and group- level safety climate subscale was 0.912 and 0.937, respectively. The confirmatory factor analysis (CFA) showed good model fit for a one-factor model of the organization-level safety climate subscale, χ² (df = 20) = 129.158, p < 0.001, CFI = 0.994, TLI = 0.992, NFI = 0.993, IFI = 0.994, RMSEA = 0.059, 90% CI = (0.050, 0.069), and SRMR = 0.048. A one-factor model also fits well for the group-level safety climate subscale, χ² (df = 44) = 219.727, p < 0.001, CFI = 0.996, TLI = 0.9925, NFI = 0.995, IFI = 0.996, RMSEA = 0.050, 90% CI = (0.044, 0.057), and SRMR = 0.046. Discrimination and difficulty parameters showed that all items effectively spanned the range of the latent trait and could successfully separate participants at different safety climate levels. Items in the organization-level and group-level Chinese safety climate subscales had significantly different discrimination parameters, fitted well with the models, and had a substantive relationship with the latent traits.

Discussion

The Chinese safety climate scale was reliable and valid overall. They can facilitate the research and survey regarding the safety climate in China.

Rasch analysis of the 32-item motor function measure in ambulant patients with Duchenne muscular dystrophy

OBJECTIVE

This study analyzed the 32-item Motor Function Measure in a cohort of ambulatory patients with Duchenne muscular dystrophy using Rasch measurement methods.

DESIGN

This is a psychometric study.

SETTING

Rehabilitation centre of a large public children's hospital in Shenzhen, China.

PARTICIPANTS

Data from 176 genetically confirmed ambulant patients with Duchenne muscular dystrophy (mean age 7.3 years, SD 2.3 years, range 3.1-13.1 years) were analyzed.

RESULTS

Rasch analyses supported the Motor Function Measure domain D1 as a reliable (person reliability  =  0.88, person separation index  =  2.71) and valid (acceptable targeting, little misfit, minimal category disordering) measure in ambulant patients with Duchenne muscular dystrophy. Remodelling the domain D1 by collapsing item 25 from 4 to 3 response categories addressed the problematic disordered thresholds, resulting in a rebuilt domain D1 with enhanced measurement properties. However, findings for domains D2 and D3 did not fulfil most Rasch model expectations. There were disordered thresholds for most items in domains D2 and D3, with low reliability coefficients, item mistargeting and misfit, and large ceiling effects.

CONCLUSION

Rasch analyses confirmed that the Motor Function Measure domain D1 was reliable and valid and provided a unidimensional measure for motor function in ambulant Duchenne muscular dystrophy patients. Accuracy of measurement had been enhanced through remodelling, and a rebuilt domain D1 with category collapsing for item 25 was proposed. The analysis revealed multiple limitations of the domains D2 and D3 that certain essential psychometrics were poorly met and, therefore, should be used with caution in this patient group.

What Are the Dry Eye Questionnaires Available in the Scientific Literature Used for? A Scoping Review

PURPOSE

Dry eye disease (DED) is a frequent chronic ophthalmic condition. Its diagnosis includes tests and patient reported outcomes (PRO) questionnaires. Although many PRO dry eye questionnaires (PRO-DEQs) are available, they differ greatly from each other and not all have been validated. The purpose of this study was to retrieve the PRO-DEQs present in the scientific literature by performing a descriptive analysis of them and identifying those with known validity and reliability characteristics and to perform a descriptive analysis of the geographic area, year of publication, and characteristics of the target population of the clinical studies that have used validated PRO-DEQs.

DESIGN

Scoping review of the literature.

METHODS

Searches were conducted in PubMed to retrieve PRO-DEQs published up to July 2018 and written in English, French, Italian or Spanish.

RESULTS

One thousand six hundred two records were identified and 973 were included in the final analysis. Of these, 56 provided information on the design and validation of PRO-DEQs and 49 PRO-DEQs were identified. Twenty-two PRO-DEQs were validated (17 original and 5 modified) and 27 had no associated design, validity, and reliability studies. Most of the validated PRO-DEQs were designed in English, the number of items varies from 1 to 57, the dimensions are generally not specified, and they are self-administered. The greatest use of validated PRO-DEQs in clinical studies has been in Asia since 2010, with the Ocular Surface Disease Index being the most used. These questionnaires have been used mostly in adults, retired professionals, and people with visual diseases to diagnose DED.

CONCLUSIONS

This study aims to encourage the use of validated PRO-DEQs to guarantee the quality of the results obtained and the comparability and replicability among studies.

Psychometric evaluation of the academic involution scale for college students in China: An application of Rasch analysis

Recent academic attention on educational involution in China underpins the need for a valid and reliable instrument to precisely measure college students' academic involution behaviors. Seeing the scarcity of a proper instrument, the current study attempted to analyze the item-level psychometric properties of the newly developed Academic Involution Scale for College Students (AISCS) in China by using a Rasch model. A total of 637 college students in a public university in northern China participated in the study. Data were examined with respect to unidimensionality, rating scale functioning, item fit statistics, item polarity, item- and person-level reliability and separation, item hierarchy and invariance across educational background with Winsteps. The results show that AISCS was a single unidimensional construct with good psychometric properties. Although two items demonstrated differential item functioning, it is plausible given the differences between assessment methods for undergraduates and postgraduates. Limitations and future research directions with regard to sample selection, inclusion of more validity evidence and adding prospective additional academic involution were discussed.

Assessing Learners’ Conceptual Understanding of Introductory Group Theory Using the CI2GT: Development and Analysis of a Concept Inventory

Prior research has shown how incorporating group theory into upper secondary school or undergraduate mathematics education may positively impact learners’ conceptual understanding of mathematics in general and algebraic concepts in particular. Despite a recently increasing number of empirical research into student learning of introductory group theory, the development of a concept inventory that allows for the valid assessment of a respective conceptual understanding constitutes a desideratum to date. In this article, we contribute to closing this gap: We present the development and evaluation of the Concept Inventory of Introductory Group Theory—the CI2GT. Its development is based on a modern mathematics education research perspective regarding students‘ conceptual mathematics understanding. For the evaluation of the CI2GT, we follow a contemporary conception of validity: We report on results from two consecutive studies to empirically justify that our concept inventory allows for a valid test score interpretation. On the one hand, we present N=9 experts‘ opinions on various aspects of our concept inventory. On the other hand, we administered the CI2GT to N=143 pre-service primary school teachers as a post-test after a two weeks course into introductory group theory. The data allow for a psychometric characterization of the instrument, both from classical and probabilistic test theory perspectives. It is shown that the CI2GT has good to excellent psychometric properties, and the data show a good fit to the Rasch model. This establishes a valuable new concept inventory for assessing students’ conceptual understanding of introductory group theory and, thus, may serve as a fruitful starting point for future research into student learning of abstract algebra.

Rasch-Validated Italian Scale for Diagnosing Digital Eye Strain: The Computer Vision Syndrome Questionnaire IT©

The use of digital devices affects eye health; this can influence the performance of workers. To assess this impact, validated patient-reported outcome questionnaires are needed. The purpose of this study was to validate the psychometric properties of the Italian version of the Computer Vision Syndrome Questionnaire (CVS-Q©) using Rasch analysis. Two hundred and forty-one Italian workers completed an ad hoc questionnaire on anamnesis and exposure to digital devices, and the Italian version of the CVS-Q©. Subsequently, a battery involving three clinical ocular surface and tear tests was performed. The reliability and validity of the scale was assessed using the Andrich Rating Scale Model, and the prevalence of computer vision syndrome (CVS) was calculated. A good fit of both items and persons to the predictions of the Rasch model was observed, with acceptable reliability, unidimensionality, and no or minimal severe differences as a function of gender or age; moreover, good test–retest repeatability, adequate values of sensitivity, reliability, and area under the curve, and adequate construct validity based on clinical tests were obtained. Workers with a questionnaire score ≥ 7 were found to present with CVS. The prevalence of CVS was 76.6%. The CVS-Q IT© is a valid and reliable scale to assess CVS in Italian workers who use digital devices.

Validation of the Symptom Questionnaire for Visual Dysfunctions (SQVD): A Questionnaire to Evaluate Symptoms of any Type of Visual Dysfunctions

Purpose

To assess psychometric properties of the Symptom Questionnaire for Visual Dysfunctions (SQVD) questionnaire, including accuracy, validity, and reliability, in a clinical sample of patients having any type of visual dysfunction.

Methods

A clinical sample of 306 patients self-administered the SQVD. Rasch analysis was performed to analyze the functionality of the response categories, fit statistics, differential item functioning (DIF), person and item reliability, targeting, local dependency, unidimensionality, and transformation table. Accuracy was assessed by means of receiver operating characteristic (ROC) curves, using symptoms reported in each patient's clinical record as the gold standard for classifying patients with and without symptoms. The concurrent validity, known group validity, and test–retest reliability (repeatability, using the intraclass correlation coefficient [ICC]) were also examined.

Results

SQVD showed orderly category responses. The 14 items fit the Rasch model without significant DIF for gender, presbyopia, and dysfunctions. Person and item reliabilities were 0.81 and 0.85, respectively. Targeting was –1.49 logits. Yen's Q3 statistic showed no local dependency. SQVD was unidimensional (first contrast of the residual = 1.852 eigenvalue with a variance explained by measures of 52.23%). The area under the ROC curve was 0.836 (95% confidence interval [CI], 0.792–0.879) with a cutoff of ≥6 showing good accuracy (sensitivity = 0.759; specificity = 0.783). SQVD showed good concurrent and known group validity and high repeatability (ICC, 0.857; 95% CI, 0.710–0.933) when administered twice 1 week apart.

Conclusions

SQVD has shown good psychometric properties. It can be considered an accurate, valid, and reliable questionnaire to detect visual symptoms related to any type of refractive, accommodative, and binocular dysfunction.

Translational Relevance

SQVD may be used for diagnostic purposes, as it can accurately detect symptoms related to any sort of visual dysfunction. It may also be useful to monitor the treatment outcomes of these conditions.

Further psychometric evaluation of the Structured Multidisciplinary Work Evaluation Tool (SMET) questionnaire: Practical implications in healthcare settings

BACKGROUND

Scientific research has identified a lack of psychometrically well-tested methods for evaluation of the work environment in healthcare settings. The Structured Multidisciplinary Work Evaluation Tool (SMET) questionnaire has been evaluated and has shown good content validity, as well as intra-rater and test-retest reliability. There are, however, still unknowns regarding the psychometric properties. If the SMET questionnaire is to be used in practical occupational health service (OHS) work and scientific research in healthcare settings, further psychometric evaluation is needed.

OBJECTIVE

The aim of this study was to gain further understanding of the psychometric properties of the SMET questionnaire when used in research and clinical OHS practice in healthcare settings.

METHODS

The psychometric evaluation was conducted using classical test theory (Cronbach's alpha, explorative factor analysis) and Rasch analysis (measurement targeting, category threshold order, person separation index) on data previously collected in development projects within the healthcare sector.

RESULTS

The results support the use of the SMET questionnaire as a psychometrically well-tested method for evaluation of the work environment in healthcare settings. They support the use of the initial 1-10 scale since all 10 steps are used. The results also support the trichotomization procedure since the trichotomized scale captures the construct of the work environment with good measurement targeting and good category threshold order.

CONCLUSION

The results of this study support the use of the SMET questionnaire as a psychometrically well-tested method for a broad multifactorial evaluation of the work environment in healthcare settings.