Confirmatory Factor Analysis of the Disablement in the Physically Active Scale and Preliminary Testing of Short-Form Versions: A Calibration and Validation Study

Psychological readiness for injury recovery: evaluating psychometric properties of the IPRRS and assessing group differences in injured physically active individuals

Objectives

The primary purpose of the study was to assess the one-factor and two-factor structure of the Injury Psychological Readiness to Return to Sport Scale (IPRRS) in an injured physically active population using confirmatory factor analysis (CFA) procedures and assess group (ie, sex, age, injury type, athlete status) and longitudinal differences using structural equation modelling (eg, invariance testing).

Methods

The non-experimental study included a sample of 629 physically active individuals who suffered a musculoskeletal injury who sought treatment at an outpatient integrated sport medicine and rehabilitation therapy clinic. Participants filled out a questionnaire packet at three time points. Data analysis included a CFA and multigroup and longitudinal invariance.

Results

Sample mean age was 26.3 years, with females comprising 49.5%. Chronic injuries represented 29.6% of the sample and 35.0% were classified as competitive athletes. A six-item, one-factor model was confirmed in the sample with factor loadings ranging from 0.67 to 0.86. Multigroup and longitudinal invariance were established. Multigroup invariance demonstrated null differences between sex and injury type, and statistical differences between age and athlete status subgroups. Longitudinal invariance demonstrated a statistically significant increase in psychological readiness over time.

Conclusions

The findings support the use of the IPRRS as a tool to measure aspects of psychological readiness. Clinicians and researchers can use the IPRRS to assess interventions in future research.

Evaluating Psychometric Properties of the International Knee Documentation Committee Subjective Knee Form in a Heterogeneous Sample of Post-Operative Patients

Background

The International Knee Document Committee Subjective Knee Form (IKDC-SKF) is a patient-reported outcome measure used in orthopedics and sports medicine. Further psychometric assessment is necessary to confirm measurement properties in a large, heterogenous sample.

Purpose

The purpose of the study was to assess the psychometric properties of the IKDC-SKF in a large, heterogenous sample.

Study Design

Cross-Sectional Study.

Methods

An exploratory factor analysis (EFA) was conducted to identify a sound latent structure and to assess internal consistency in a large sample of patients who underwent knee arthroscopy. A confirmatory factor analysis (CFA) was conducted to confirm structural validity. Multi-group invariance was conducted to assess factorial stability across sex and age groups, while longitudinal invariance procedures were performed to assess stability over time.

Results

A 3-factor, 9-item IKDC-SKF short form was identified with EFA procedures. The model was confirmed with CFA (CFI = 0.983; TLI = 0.975; IFI = 0.983; RMSEA = 0.057), while a sound 2-factor, 6-item model was also identified (CFI = 1.0; TLI = 0.999; IFI = 1.0; RMSEA = 0.11). The 9-item IKDC-SKF short form was invariant across groups but not time; removal of a single item (i.e., 8-item IKDC-SKF short form) resulted in longitudinal invariance. The 6-item IKDC-SKF short form was invariant across groups and time.

Conclusion

The 6-item, 8-item, and 9-item short form versions of the IKDC-SKF exceed contemporary fit recommendations and present as plausible alternatives to the IKDC-SKF with improved measurement properties, reduced scale response burden, and evidence of multi-group and longitudinal invariance. Further, the 6- and 8-item IKDC-SKF short forms may be used to assess group differences or change across time.# Level of evidence hereLevel 3©The Author(s).

The Validity and Reliability of the Turkish Version of the Disablement in the Physically Active Scale

CONTEXT

The Disablement in the Physically Active Scale (DPAS) was recently developed to evaluate the disability process and health-related quality of life. The aim of this study was to investigate the validity and reliability of the Turkish version of the DPAS in physically active individuals with musculoskeletal injury.

METHODS

The study sample comprised 64 physically active individuals with musculoskeletal injury aged 16-40 years. The DPAS was translated into Turkish according to the guidelines for cross-cultural adaptation. Short Form-36 was used concurrently to test the construct validity. The test-retest reliability of the Turkish version of the scale assessed by intraclass correlation coefficient and Cronbach α was calculated for internal consistency.

RESULTS

Confirmatory factor analysis carried out on the Turkish version of the DPAS was confirmed. Cronbach α was calculated to be .946. The intraclass correlation coefficients ranged between .593 and .924 (P < .001). The Turkish version of the scale showed significant correlations with domains of the Short Form-36 (P < .05). When the sensitivity of the study was evaluated, the highest correlation was found between DPAS total score and impairments (r = .906, P = .001), and the lowest correlation was  between DPAS total score and quality of life (r = .637, P = .001).

CONCLUSION

The Turkish version of the DPAS is a reliable, valid, and practical tool. The Turkish version of the DPAS can be used by health professionals to understand quality of life, the disability process, and activity limitations in Turkish-speaking physically active people after musculoskeletal injuries.

The Knowledge and Use of the International Classification of Functioning, Disability and Health (ICF) Framework in Athletic Training

In 2015, the Strategic Alliance adopted the International Classification of Functioning, Disability, and Health (ICF) as the disablement model framework for delivery of and communication about patient care in athletic training. The purpose of this study was to examine athletic trainers' familiarity, knowledge, application, and implementation of the ICF framework. We used a cross-sectional online survey with 185 athletic trainers (age = 35 ± 9 y), which included 32 items focused on familiarity, knowledge, application, and implementation of the ICF framework. Most participants (n = 96, 51.9%) reported never learning about the ICF framework. During the knowledge assessment, participants scored 4.3 ± 2.7 out of 8, which is equivalent to 53.7%. For the sorting assessment, participants scored 10.9 ± 3.9 out of 18, which is equivalent to 60.5%. On the implementation matrix, the most frequently reported ICF tasks elicited by the athletic trainers included neuromusculoskeletal and movement, structure related to movement, and mobility. The most common 'never elicited' ICF tasks included voice and speech, sexual orientation, and structures related to genitourinary and reproductive system. Deficits related to the ICF framework exist. Athletic trainers reported low implementation across all ICF categories. The decision to not elicit information on these areas of health may reduce the ability to provide patient-centered healthcare.

Psychometric Properties of a Modified Athlete Burnout Questionnaire in the Collegiate Athletics Setting

CONTEXT

Mental health is an important component of holistic care in athletic settings. Burnout is one of many factors associated with poor mental health, and clinicians should assess for these symptoms. The Athlete Burnout Questionnaire (ABQ) has been proposed as a measure of burnout in athletes; however, design concerns are prevalent within the scale, and psychometric analyses have resulted in inconsistent measurement properties, limiting the usefulness of the scale for accurate assessment of burnout in athletes. The objective of our study was to assess the factor structure of the Alternate Modified ABQ-15v2 using confirmatory factor analysis. If model fit was inadequate, a secondary purpose was to identify a psychometrically sound alternate ABQ model.

DESIGN

Observational study.

METHODS

Intercollegiate athletes and dancers pursuing a degree in dance (n = 614) were recruited from programs across the United States. Individuals had varied health statuses (eg, healthy, injured), scholarship support, and participated in a variety of intercollegiate sports. A confirmatory factor analysis was conducted on the modified 15-item ABQ (Alternate Modified ABQ-15v2). Exploratory factor analysis and covariance modeling of a proposed alternate 9-item scale (ABQ-9) was conducted and multigroup invariance analysis was assessed across athlete category, class standing, and student-athlete scholarship status to assess consistency of item interpretation across subgroups.

RESULTS

The Modified ABQ did not meet recommended model fit criteria. The ABQ-9 met all recommended model fit indices but was not invariant across athlete category.

CONCLUSIONS

The ABQ-9 may be a viable and efficient option for assessing burnout in the collegiate athletics setting. However, further research is needed to validate the ABQ-9 in a cross-validation study.

Confirmatory Factor Analysis of the Athlete Sleep Behavior Questionnaire

CONTEXT

Sleep has long been understood as an essential component for overall well-being, substantially affecting physical health, cognitive functioning, mental health, and quality of life. Currently, the Athlete Sleep Behavior Questionnaire (ASBQ) is the only known instrument designed to measure sleep behaviors in the athletic population. However, the psychometric properties of the scale in a collegiate student-athlete and dance population have not been established.

OBJECTIVE

To assess model fit of the ASBQ in a sample of collegiate traditional student-athletes and dancers.

DESIGN

Observational study.

SETTING

Twelve colleges and universities.

PATIENTS OR OTHER PARTICIPANTS

A total of 556 (104 men, 452 women; age = 19.84 ± 1.62 years) traditional student-athletes and dancers competing at the collegiate level.

MAIN OUTCOME MEASURE(S)

A confirmatory factor analysis (CFA) was computed to assess the factor structure of the ASBQ. We performed principal component analysis extraction and covariance modeling analyses to identify an alternate model. Multigroup invariance testing was conducted on the alternate model to identify if group differences existed for sex, sport type, injury status, and level of competition.

RESULTS

The CFA on the ASBQ indicated that the model did not meet recommended model fit indices. An alternate 3-factor, 9-item model with improved fit was identified; however, the scale structure was not consistently supported during multigroup invariance testing procedures.

CONCLUSIONS

The original 3-factor, 18-item ASBQ was not supported for use with collegiate athletes in our study. The alternate ASBQ was substantially improved, although more research should be completed to ensure that the 9-item instrument accurately captures all dimensions of sleep behavior relevant for collegiate athletes.

A Descriptive Analysis of Patient Outcomes and Experiences at a Student-Run Athletic Training Clinic

CONTEXT

The prevalence of student-run clinics is rising due to educational benefits and the ability to provide cost-effective care to underserved patients. Current literature on the effect of athletic training student-run clinics on patient outcomes and experiences is limited.

OBJECTIVE

To explore patient-reported outcomes (PROs), patient experiences, and patient demographics in an athletic training student-run clinic.

DESIGN

Mixed-methods study: cross-sectional survey with retrospective analysis of deidentified patient outcomes from November 2017-October 2021.

SETTING

Athletic training student-run clinic.

PATIENTS OR OTHER PARTICIPANTS

A total of 388 patients from the university (ie, students and staff) and local community with a variety of musculoskeletal injuries.

MAIN OUTCOME MEASURE(S)

Participants completed a packet to provide their responses to demographic items and PRO scales: Disablement in the Physically Active Scale Short Form-8, Numeric Pain Rating Scale, Patient-Specific Functional Scale, and Global Rating of Change Scale at 3 time points. They also completed an electronic patient experience survey after their final visit to the student-run clinic.

RESULTS

Most participants reported clinically significant improvements across all PRO scales: an average improvement of 39.1% in pain, 39.3% in function, and 43.1% in quality of life in <11 days, on average. Furthermore, they described a high level of satisfaction with care and a globally positive experience at the student-run clinic.

CONCLUSIONS

Patients experienced clinically significant improvements in pain, function, disablement, and quality of life when receiving care from athletic training students at a student-run clinic. In addition, they indicated a high level of satisfaction with the care provided and a positive overall experience with an athletic training student-run clinic.

Disablement in the Physically Active Scale Short Form-8: psychometric evaluation

Background

Patient-centered care and evidence-based practice (EBP) are core competencies for health care professionals. The importance of EBP has led to an increase in research involving clinical outcomes; current recommendations emphasize collecting patient focused measures, thus increasing the need for psychometrically sound patient reported outcome measures (PROMs) of health. Disablement has been identified as a valuable multi-dimensional construct for patient care. The Disablement in the Physically Active Scale Short Form-8 (DPA SF-8) has been proposed as a tool to be used in the physically active population that assesses a physical summary component of health and a quality of life component however, further analysis is necessary to ensure the instrument is psychometrically sound.

Methods

Confirmatory factor analyses (CFAs) were conducted on the DPA SF-8 at each time point to ensure factor structure. Reliability of the scale and internal consistency of the subscales were assessed, and a minimal detectable change (MDC) calculated. Additionally, a minimal clinically important difference (MCID) was also established, and invariance testing across three time points and groups was conducted.

Results

The CFAs at all three visits exceeded recommended model fit indices. The interclass correlation coefficient value (.924) calculated indicated excellent scale reliability and Cronbach’s alpha for subscales PHY and QOL were within recommend values. The MDC value calculated was 5.83 and the MCID for persistent injuries were 2 points and for acute injuries, 3 points. The DPA SF-8 was invariant across time and across subgroups.

Conclusions

The DPA SF-8 met CFA recommendations and criteria for multi-group and longitudinal invariance testing, which indicates the scale may be used to assess for differences between the groups or across time. Our overall analysis indicates the DPA SF-8 is a valid, reliable, and responsive instrument to assess patient improvement in the physically active population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-021-00380-3.

Searching for the Holy Grail: A Systematic Review of Health-Related Quality of Life Measures for Active Youth

OBJECTIVE

To identify the most suitable existing generic and condition-specific health-related quality of life (HRQoL) patient-reported outcome measures (PROMs) for active youth with and without a musculoskeletal injury, based on measurement properties, interpretability, and feasibility.

DESIGN

Systematic review of clinimetrics.

LITERATURE SEARCH

We searched MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO, and Scopus from inception to April 30, 2020.

STUDY SELECTION CRITERIA

Records with original data describing the evaluation of a PROM or PROM subscale in active youth (15-24 years old) with or without a musculoskeletal injury were included. Non-English studies and those including individuals with a cognitive, developmental, or systemic condition were excluded.

DATA SYNTHESIS

This review was conducted according to the COSMIN user manual for systematic reviews of PROMs and the PRISMA guidelines. The COSMIN user manual guided our measurement property evaluation and interpretability and feasibility description.

RESULTS

Of 6931 potential records, 21 studies were included. Eleven generic and 7 condition-specific PROMs were identified. No PROM received a final COSMIN recommendation of "A" because all lacked sufficient content validity. The 8-item Disablement in the Physically Active scale-mental summary component Short Form (DPA-MSC SF-8), Quality of Life Survey, and Functional Arm Scale for Throwers (FAST) were the most suitable existing PROMs, given their high-quality evidence for sufficient structural validity and internal consistency.

CONCLUSION

No definitively robust PROM for measuring generic or condition-specific HRQoL of active youth was identified. Until one exists, we recommend the DPA-MSC SF-8, the Quality of Life Survey, or the FAST and applying mixed methods to best characterize the HRQoL of active youth. J Orthop Sports Phys Ther 2021;51(10):478-491. doi:10.2519/jospt.2021.10412.

Invariance Testing of the Disablement in the Physically Active Scale Short Form-10

INTRODUCTION

Psychometrically sound instruments are needed to accurately track treatment effectiveness and assess quality of patient care. The Disablement in Physically Active Scale Short Form-10 (DPAS-10) was developed as a more parsimonious version of the DPA Scale to assess disablement in the physically active. Psychometric assessment of the DPAS-10 has not been completed; specifically, scale properties must be assessed in a sample of individuals who only respond to the 10-item scale at multiple time points.

OBJECTIVES

To assess the psychometric properties of the DPAS-10 using confirmatory factor analysis (CFA) and invariance procedures across multiple time points.

METHODS

Confirmatory factor analyses and longitudinal invariance tests were conducted.

RESULTS

The DPAS-10 met contemporary fit index recommendations and demonstrated longitudinal invariance; however, localized fit issues suggest further modification is needed.

CONCLUSION

Adoption of the DPAS-10 into widespread clinical practice and research is not recommended until further psychometric testing and scale modification is performed.

When CAT is not an option: complementary methods of test abbreviation for neurocognitive batteries

INTRODUCTION

There is an obvious need for efficient measurement of neuropsychiatric phenomena. A proven method-computerized adaptive testing (CAT)-is not feasible for all tests, necessitating alternatives for increasing test efficiency.

METHODS

We combined/compared two methods for abbreviating rapid tests using two tests unamenable to CAT (a Continuous Performance Test [CPT] and n-back test [NBACK]). N=9,498 (mean age 14.2 years; 52% female) were administered the tests, and abbreviation was accomplished using methods answering two questions: what happens to measurement error as items are removed, and what happens to correlations with validity criteria as items are removed. The first was investigated using quasi-CAT simulation, while the second was investigated using bootstrapped confidence intervals around full-form-short-form comparisons.

RESULTS

Results for the two methods overlapped, suggesting that the CPT could be abbreviated to 57% of original and NBACK could be abbreviated to 87% of original with the max-acceptable loss of precision and min-acceptable relationships with validity criteria.

CONCLUSIONS

This method combination shows promise for use in other test types, and the divergent results for the CPT/NBACK demonstrate the methods' abilities to detect when a test should not be shortened. The methods should be used in combination because they emphasize complementary measurement qualities: precision/validity..

Invariance Testing of the Disablement in the Physically Active Scale

CONTEXT

The increased emphasis on implementing evidence-based practice has reinforced the need to more accurately assess patient improvement. Psychometrically sound, patient-reported outcome measures are essential for evaluating patient care. A patient-reported outcome instrument that may be useful for clinicians is the Disablement in the Physically Active Scale (DPAS). Before adopting this scale, however, researchers must evaluate its psychometric properties, particularly across subpopulations.

OBJECTIVE

To evaluate the psychometric properties of the DPAS in a large sample using confirmatory factor analysis procedures and assess structural invariance of the scale across sex, age, injury status, and athletic status groups.

DESIGN

Observational study.

SETTING

Twenty-two clinical sites.

PATIENTS OR OTHER PARTICIPANTS

Of 1445 physically active individuals recruited from multiple athletic training clinical sites, data from 1276 were included in the analysis. Respondents were either healthy or experiencing an acute, subacute, or persistent musculoskeletal injury.

MAIN OUTCOME MEASURE(S)

A confirmatory factor analysis was performed on the full sample, and multigroup invariance testing was conducted to assess differences across sex, age, injury status, and athletic status. Given the poor model fit, alternate model generation was used to identify a more parsimonious factor structure.

RESULTS

The DPAS did not meet contemporary fit index recommendations or the criteria to demonstrate structural invariance. We identified an 8-item model that met the model fit recommendations using alternate model generation.

CONCLUSIONS

The 16-item DPAS did not meet the model fit recommendations and may not be the most parsimonious or reliable measure for assessing disablement and quality of life. Use of the 16-item DPAS across subpopulations of interest is not recommended. More examination involving a true cross-validation sample should be completed on the 8-item DPAS before this scale is adopted in research and practice.

Exploring the Psychometric Properties of the Disablement in the Physically Active Scale Short Form-8 in Adolescents

CONTEXT

Patient-reported outcomes are widely used in health care. The Disablement in the Physically Active (DPA) Scale Short Form-8 (SF-8) was recently proposed as a valid scale for the physically active population. However, further psychometric testing of the DPA SF-8 has not been completed, and scale structure has not been assessed using a sample of adolescent athletes.

OBJECTIVE

To assess scale structure of the DPA SF-8 in a sample of adolescent high-school athletes.

MAIN OUTCOME MEASURE(S)

Adolescent athletes (n = 289) completed the DPA SF-8. Confirmatory factor analysis (CFA) was conducted to assess the psychometric properties of the scale.

RESULTS

The CFA of the DPA SF-8 indicated that the model exceeded recommended fit indices (Comparative Fit Index = .976, Tucker-Lewis Index = .965, Root Mean Square Error of Approximation = .061, and Bollen's Incremental Fit Index = .976). All factor loadings were significant and ranged from .62 to .86. Modification indices did not suggest that meaningful cross-loadings were present or additional specifications that could further maximize fit or parsimony.

CONCLUSIONS

The CFA of the DPA SF-8 met contemporary model fit recommendations in the adolescent athlete population. The results confirmed initial findings supporting the psychometric properties of the DPA SF-8 as well as the uniqueness of the quality-of-life and physical summary factors in an adolescent population. Further research (eg, reliability, invariance between groups, minimal clinically important differences, etc) is warranted to inform scale use in clinical practice and research.