From dysphonia to dysphoria: Mokken scaling shows a strong, reliable hierarchy of voice symptoms in the Voice Symptom Scale questionnaire

Vocal Tract Discomfort Scale-Brazil (VTDS-BR): Validation Based on Internal Consistency, Reliability, and Accuracy

OBJECTIVE

To validate the Vocal Tract Discomfort Scale for the Brazilian Portuguese (VTDS-BR), based on internal consistency, reliability, and accuracy.

METHODS

The participants were 431 adults of both sexes, divided in two groups: dysphonia (DG) and vocally healthy (VHG). We built a digital database with personal, professional information and the item-by-item VTDS-BR responses of the participants. We applied Cronbach's alpha, exploratory factor analysis; confirmatory factor analysis; Item Response Theory (IRT) using the Samejima model; and ROC (Receiver Operating Characteristic) curve analysis to obtain the VTDS-BR cut-off point.

RESULTS

The VTDS-BR has an eight-item structure and two factors: vocal hyperfunction without phonotraumatic injury and with phonotraumatic injury. Each item is evaluated based on two facets related to frequency and intensity, with a Likert scale response key. There are four possible answers: never, sometimes, often, and always for frequency and none, mild, moderate, and intense for intensity. We applied an IRT model, which allowed the identification of which items are more related to dysphonia, based on higher values in the parameters discrimination (a) and difficulty (b), which contributed to the calculation of each participant's aptitude for the development of voice problems, by means of a score. The cut-off value was determined using the ROC curve, in which values greater than - 1.432 indicate a higher probability of voice alterations.

CONCLUSION

VTDS-BR went through the stages of validation of internal consistency, reliability, and accuracy. It presents an 8-item, two-factor, and two-facet structure to assess frequency and intensity of vocal tract discomfort symptoms. VTDS-BR is suitable for clinical use or in screening activities, as it is quick to apply and its interpretation is indicative of people with and without phonotraumatic injury.

A unidimensional short form of the Beck Hopelessness Scale (BHS-7) derived using item response theory

The Beck Hopelessness Scale (BHS) is the most widely used measure of hopelessness, a key psychological construct linked with various mental health outcomes. In clinical settings, the BHS has proven a reliable tool for assessing hopelessness; however, there has been debate regarding the tool's internal consistency among non-clinical populations. Most studies assessing the dimensionality of the BHS have relied on the use of classical test theory (CTT). The length of the BHS has also prompted concerns over its practicality. The BHS-9 was developed to address these critiques and formulated based on psychiatrically hospitalized adult patients. The current study investigates the dimensionality of the BHS-9 among a non-clinical sample using item response theory (Mokken scale analysis and Rasch) and CTT. The results confirm that the BHS-9 is essentially unidimensional. However, a salient finding was that Item 6 violated invariant item ordering. An exploratory factor analysis of the remaining eight items found that the items accounted for 48.05% of the variance. Further exploratory factor analyses, removing one item at a time, showed that the removal of item 18 would increase variance explained > 50%. The revised BHS-7 was found to be unidimensional and maintained strong internal consistency and criterion-related validity. This revised tool effectively captures the essence of hopelessness among a non-clinical population and presents a more refined option for the assessment of this construct.

Validation of the Brazilian Scale of Perceived Control Over Voice in the Present using Item Response Theory

OBJECTIVE

this study aims to verify the stages of evidence of validity of the voice-adapted present perceived control scale (V-APPCS) in its translated and cross-culturally adapted version for the Brazilian Portuguese "Voice-Adapted Present Perceived Control Scale" and to estimate the psychometric measurements of the properties of its items based on the item response theory (IRT).

METHODS

the instrument underwent a process of translation and cross-cultural adaptation for the Brazilian Portuguese, the process was carried out by two qualified translators, native in the destination language, and fluent in the language and culture of origin. The first translated version of the protocol was forwarded to a back-translation, performed by a third bilingual Brazilian translator. The translations were analyzed and compared by a committee composed of five speech therapists who are specialists in voice and with proficiency in the English language. The empirical study used data from 168 individuals, 127 had voice problems and 41 vocally healthy ones. For the stages of validity evidence, the following analyses were performed: Cronbach's alpha, exploratory factor analysis, confirmatory factor analysis and IRT.

RESULTS

The stages of translation and cross-cultural adaptation allowed linguistic adjustments to be made so that the items were understandable and suitable for use in Brazil. The adequacy, structure, and application of the items were confirmed through the application of the final version of the scale in twenty individuals in a real context. The instrument in its Brazilian version presented good internal consistency, with bifactorial structure the exploratory factor analysis, besides presenting satisfactory values in the adjustment indexes of the model, confirming the structure of the confirmatory factor Analysis. The IT was applied to evaluate the parameters discrimination (a) and difficulty (b) of the items of the instrument; item 5 "I have control over my day-to-day reactions to the voice problem." Presented itself as a more discriminative item and item 8 "My reaction to the voice problem is not under my control." As an item of greater difficulty.

CONCLUSION

The V-APPCS, translated, cross-culturally adapted, and validated, is robust and adequate to represent the construct in the Brazilian versions.

Validation of the Self-assessment of Communication Competence (SACCom) in Brazilian Portuguese Through Item Response Theory

OBJECTIVE

To evaluate the validity of the Self-assessment of Communication Competence - SACCom by analyzing the communication competency of adult individuals using the item response theory (IRT).

METHODS

Overall, 778 individuals who responded to SACCom participated in this study. The initial version consisted of 20 polytomous items regarding communication skills. Polytomous answer keys to each item were ordered as follows: 1 - no, 2 - more or less, and 3 - yes. The IRT and the gradual response model, a 2-parameter logistic model for polytomous items, were used for validation.

RESULTS

Due to problems in the preliminary analysis using the item characteristic curve (ICC), answer keys to SACCom items were reorganized in an ordinal dichotomous way. Response 1 was coded as 0 - no, while responses 2 and 3 were coded as 1 - yes. Item 9 of the ICC was problematic and did not add information to the instrument; hence, this item was excluded. SACCom, in its dichotomous format with 19 items, was unidimensional according to the eigenvalues graph and tetrachoric correlation analysis. The Cronbach's alpha coefficient showed an internal consistency value of 0.711. All item-total correlations were greater than 0.284. Item discrimination parameters ranged from a = 0.563 to a = 1.505, and the difficulty of the items ranged between b = -2.725 and b = 0.612. The likelihood ratio test showed that the model without restrictions best fit the data. ICC gleaned more information for individuals with lower communication skills.

CONCLUSION

The 19-item, dichotomous SACCom is valid for the analysis of communication skills according to the IRT.

Reducing the GAP between science and clinic: lessons from academia and professional practice - part A: perceptual-auditory judgment of vocal quality, acoustic vocal signal analysis and voice self-assessment

During the XXVIII Brazilian Congress of SBFa, 24 specialists met and, from a leading position on scientific research as a tool for connecting laboratory and clinic, five fronts of knowledge of the voice specialty were discussed as following: Perceptual-auditory judgment of vocal quality; 2. Acoustic analysis of the vocal signal; 3. Voice self-assessment; 4. Traditional techniques of therapy; 5. Modern techniques of electrostimulation and photobiomodulation (PBMT) in voice. Part "a" of this publication was associated with the consolidation of the analyses of the first three aspects. The trend in the perceptual-auditory judgment of vocal quality was related to the use of standard protocols. The acoustic evaluation of the vocal signal is accessible and can be done descriptively or by extraction of parameters, thus preferring multiparametric measures. Finally, the analysis of the individual himself closes this triad of voice documentation, which will be the basis for the conclusion of the evaluation, reference for monitoring progress, and evaluation of treatment results.

Reducing the GAP between science and clinic: lessons from academia and professional practice - part A: perceptual-auditory judgment of vocal quality, acoustic vocal signal analysis and voice self-assessment

ABSTRACT During the XXVIII Brazilian Congress of SBFa, 24 specialists met and, from a leading position on scientific research as a tool for connecting laboratory and clinic, five fronts of knowledge of the voice specialty were discussed as following: Perceptual-auditory judgment of vocal quality; 2. Acoustic analysis of the vocal signal; 3. Voice self-assessment; 4. Traditional techniques of therapy; 5. Modern techniques of electrostimulation and photobiomodulation (PBMT) in voice. Part “a” of this publication was associated with the consolidation of the analyses of the first three aspects. The trend in the perceptual-auditory judgment of vocal quality was related to the use of standard protocols. The acoustic evaluation of the vocal signal is accessible and can be done descriptively or by extraction of parameters, thus preferring multiparametric measures. Finally, the analysis of the individual himself closes this triad of voice documentation, which will be the basis for the conclusion of the evaluation, reference for monitoring progress, and evaluation of treatment results.

Factor Analysis of the Brazilian Version of the Voice-Related Quality of Life (V-RQOL) Questionnaire

OBJECTIVE

To investigate the psychometric properties of the Voice-Related Quality of Life (V-RQOL) questionnaire in Brazilian Portuguese by assessing its reliability and conducting exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

METHODS

This research was carried out in two stages: (1) a document-based retrospective approach and (2) a field study step. The study included 566 dysphonic and vocally healthy individuals. For data collection, the Vocal Screening Protocol and the V-RQOL questionnaire were used, and these measures were later statistically analyzed through descriptive analysis, reliability tests, CFA, and EFA. Ethical issues were considered.

RESULTS

A Cronbach's alpha coefficient of 0.916 was observed, indicating good internal consistency for the V-RQOL questionnaire. The item-total correlation coefficient indicated that the items had good correlation with each other and with the construct, with values higher than 0.30. EFA was performed based on the Kaiser-Meyer-Olkin index and Bartlett's test of sphericity, which indicated the adequacy of the tested sample. The items presented commonality of >0.30 and satisfactory factor loadings, resulting in a single factor. The unifactorial structure of the V-RQOL questionnaire was confirmed by CFA.

CONCLUSION

EFA and CFA indicated that a single factor should be adopted to encompass all the items of the V-RQOL questionnaire.

Reliability and Validation of the Turkish Version of the Pediatric Voice-Related Quality of Life Survey

OBJECTIVE

To evaluate the effect of dysphonia in children, several methods have been developed, including the Pediatric Voice Outcome Survey, the Pediatric Voice Handicap Index, and the Pediatric Voice-Related Quality of Life (PVRQOL) Survey. The aim of this study was to analyze the validity of the Turkish version of the PVRQOL Survey.

METHODS

The PVRQOL Survey consists of 10 questions that evaluate the effects of dysphonia on quality of life. We translated it into Turkish by working with two translators and faculty from the English Grammar and Literature Department. The Turkish version was translated back into English by two bilingual individuals to assess accuracy. The final version was tested by 15 parents for pilot study. Following the pilot study, we enrolled 52 children who had been admitted to the outpatient clinic with dysphonia and 79 children who had no voice complaints. The parents of the children under 7 years were asked to answer the survey. Children aged between 7 and 9 years completed the survey with their parents, and children over 9 years completed the survey by themselves.

RESULTS

The results of the pilot study revealed no difference between the two groups. Intergroup comparisons revealed that there were statistically significant differences between the control and patient groups in terms of question responses. When the total scores of the two groups were compared, there was a significant difference.

CONCLUSION

The Turkish version is a valid and reliable instrument for assessing dysphonic patients and healthy subjects.

How do voice restoration methods affect the psychological status of patients after total laryngectomy?

OBJECTIVE

This study investigated the relationship between psychological well-being and different voice rehabilitation methods in total laryngectomy patients.

METHODS

The study enrolled 96 patients who underwent total laryngectomy. The patients were divided into three groups according to the voice rehabilitation method used: esophageal speech (24 patients); a tracheoesophageal fistula and Provox 2 voice prosthesis (57 patients); or an electrolarynx (15 patients). The participants were asked to complete the Turkish version of the Voice Handicap Index-10 (VHI-10) to assess voice problems. They were also asked to complete the Turkish version of the Perceived Stress Scale (PSS), and the Hospital Anxiety and Depression Scale (HADS). The test scores of the three groups were compared statistically.

RESULTS

Patients who used esophageal speech had a mean VHI-10 score of 10.25 ± 3.22 versus 19.42 ± 5.56 and 17.60 ± 1.92 for the tracheoesophageal fistula and Provox 2 and electrolarynx groups respectively, reflecting better perception of their voice. They also had a PSS score of 11.38 ± 3.92, indicating that they felt less stressed in comparison with the tracheoesophageal fistula and Provox 2 and electrolarynx groups, which scored 18.84 ± 5.50 and 16.20 ± 3.49 respectively. The HADS scores of the groups were not different, indicating that the patients' anxiety and depression status did not vary.

CONCLUSION

Patients who used esophageal speech perceived less stress and were less handicapped by their voice.

Pragmatic detection of anxiety and depression in a prospective cohort of voice outpatient clinic attenders

OBJECTIVE

To evaluate diagnostic performance of the emotional domain of the VoiSS questionnaire compared with the Hospital Anxiety and Depression Scale (HADS).

DESIGN

Cross-sectional questionnaire study.

SETTING

Tertiary referral centre voice clinic.

PARTICIPANTS

210 consecutive voice clinic patients.

MAIN OUTCOME MEASURES

Screening with VoiSS and HADS questionnaires. Paired comparison, correlation, multinomial logistic regression and receiver-operating characteristic (ROC) curve analysis.

RESULTS

A total of 177 returned complete data sets. Ninety-six patients (54.2%) had functional dysphonia, and 81 (45.8%) had organic laryngeal disorders. Mean total VoiSS score = 39.7/120 (standard deviation (sd) 22.2). Mean emotional VoiSS subscale = 7.6/22 (sd 7.5). Mean HADS anxiety = 6.5/21 (sd 5.2) and depression mean = 7.1/21 (sd 4.8). There were 35 (20%) borderline anxiety and/or depression scores and 30 (17%) scores considered positive for 'caseness'. There was strong correlation between emotional VoiSS and HADS anxiety (Spearman's Rho = 0.68, P < 0.001) and HADS depression (Spearman's Rho = 0.62, P < 0.001). ROC curve analysis exhibited significant association between emotional VoiSS and HADS 'caseness' (area under curve = 0.88). In addition, functional dysphonia patients had lower mean VoiSS and HADS scores than patients with identifiable laryngeal abnormalities.

CONCLUSION

The VoiSS emotional subscale strongly correlates with HADS anxiety and depression scores and could be used as a measure of psychological distress. This could allow targeted psychological strategies, without additional psychometric questionnaires. Functional dysphonia has less association with psychological distress than certain organic laryngological disorders.

Relação entre os sintomas vocais, intensidade do desvio vocal e diagnóstico laríngeo em pacientes com distúrbios da voz

RESUMO Objetivo investigar se existe associação entre a frequência de ocorrência dos sintomas vocais, a intensidade do desvio vocal e o diagnóstico laríngeo em pacientes com diferentes distúrbios da voz. Métodos Participaram do estudo 330 pacientes com queixa vocal, distribuídos em cinco grupos de acordo com o diagnóstico laringológico: G1-sem lesão laríngea, G2-lesões benignas das pregas vocais, G3-distúrbio neurológico da voz, G4-fenda glótica sem causa orgânica ou neurológica e G5-distúrbio de voz secundário a refluxo gastroesofágico. Foram alocados em cinco grupos, de acordo com o diagnóstico laríngeo. Todos os participantes responderam à Escala de Sintomas Vocais (ESV) e gravaram a vogal /ɛ/ sustentada, que foi analisada quanto à intensidade do desvio vocal por meio de uma escala analógico-visual. Resultados Houve diferença nos escores total, de limitação e físico da ESV entre diferentes grupos diagnósticos. Pacientes com lesão na porção membranosa das pregas vocais apresentaram maior número de sintomas vocais em relação aos outros grupos diagnósticos. Observou-se correlação positiva entre a intensidade do desvio vocal e os escores total, de limitação e emocional da ESV. Pacientes com desvio vocal moderado e intenso apresentaram maior número de sintomas vocais que pacientes com vozes saudáveis ou com desvio leve. Conclusão Existe associação entre o diagnóstico laríngeo, a intensidade do desvio vocal e a frequência de ocorrência dos sintomas vocais. Pacientes com lesão benigna nas pregas vocais e com desvio vocal mais intenso apresentam maior frequência de sintomas vocais.

Psychological effects of dysphonia in voice professionals

OBJECTIVES/HYPOTHESIS

To evaluate the psychological effects of dysphonia in voice professionals compared to non-voice professionals and in both genders.

STUDY DESIGN

Cross-sectional analysis.

METHODS

Forty-eight 48 voice professionals and 52 non-voice professionals with dysphonia were included in this study. All participants underwent a complete ear, nose, and throat examination and an evaluation for pathologies that might affect vocal quality. Participants were asked to complete the Turkish versions of the Voice Handicap Index-30 (VHI-30), Perceived Stress Scale (PSS), and the Hospital Anxiety and Depression Scale (HADS). HADS scores were evaluated as HADS-A (anxiety) and HADS-D (depression). Dysphonia status was evaluated by grade, roughness, breathiness, asthenia, and strain (GRBAS) scale perceptually. The results were compared statistically.

RESULTS

Significant differences between the two groups were evident when the VHI-30 and PSS data were compared (P = .00001 and P = .00001, respectively). However, neither HADS score (HADS-A and HADS-D) differed between groups. An analysis of the scores in terms of sex revealed that females had significantly higher PSS scores (P = .006). The GRBAS scale revealed no difference between groups (P = .819, .931, .803, .655, and .803, respectively). No between-sex differences in the VHI-30 or HADS scores were evident

CONCLUSIONS

We found that voice professionals and females experienced more stress and were more dissatisfied with their voices.

LEVEL OF EVIDENCE

4.

Sintomas vocais de futuros profissionais da voz

OBJETIVO: caracterizar os sintomas vocais de futuros profissionais da voz conforme as variáveis idade, sexo e índice de massa corporal. MÉTODOS: os participantes responderam a Escala de Sintomas Vocais, composta por 30 questões, sendo 15 do domínio limitação, oito do domínio emocional e sete do domínio físico. Os indivíduos foram orientados a assinalar a resposta que correspondesse à frequência de ocorrência para cada um dos sintomas questionados. Foram coletados também dados ocupacionais, antropométricos e de saúde geral.Os dados foram analisados descritivamente e estatisticamente por meio dos testes não paramétricos Correlação de Spearman, Mann Whitney e Kruskal-Wallis, com nível de significância de 5%. RESULTADOS: a amostra constituiu-se de 47 indivíduos, com idades entre 19 e 37 anos (média de 22,17 anos), sendo 28 (59,57%) do sexo feminino e 19 (40,43%) do sexo masculino,a média foi de 11,38 problemas vocais, de uma possibilidade total de 30. Houve maior frequência dos sintomas "você tosse ou pigarreia" e "você tem dificuldade para falar em locais barulhentos". CONCLUSÃO: o grupo de futuros profissionais da voz analisado apresentou alta média de sintomas vocais, salientando-se a tosse ou pigarro e a dificuldade para falar em locais barulhentos, diretamente relacionados a usos vocais incorretos. Com o aumento da demanda vocal profissional esses indivíduos poderão ser considerados de risco para o desenvolvimento de distúrbios vocais.

Epidemiological voice health map of the teaching population of Granollers (Barcelona) developed from the EVES questionnaire and the VHI

The aim of this research project was to carry out an epidemiological study on the voice health of the teaching population in Granollers (Barcelona) using the EVES questionnaire and to relate the collected data to the VHI results. The study sample consisted of 233 teachers from Granollers (Barcelona). The EVES questionnaire, which includes the VHI-10, was conducted online. A high percentage of the teachers consulted suffered voice disorders, which ranged from minor to more serious cases. In regard to the data obtained using the VHI, in 28.77% of the cases there was a moderate or a serious perception of voice problems. Out of these cases only one person, who had a moderate perception of their problem, was undergoing voice therapy with a speech therapist. There are three questions in the EVES questionnaire that can efficiently indicate the existence of a voice disorder in a straightforward manner, and the results for these were similar to those recorded for the VHI group of questions. Therefore, it may be argued that questions that refer to the perception of the degree of pleasantness of one's own voice should be included, because they would provide a useful way to indicate whether there is a voice problem at a preliminary screening stage.

Scalability and internal consistency of the German version of the dementia-specific quality of life instrument QUALIDEM in nursing homes - a secondary data analysis

BACKGROUND

Quality of life (Qol) is a widely selected outcome in intervention studies. The QUALIDEM is a dementia-specific Qol-instrument from The Netherlands. The aim of this study is to evaluate the scalability and internal consistency of the German version of the QUALIDEM.

METHODS

This secondary data analysis is based on a total sample of 634 residents with dementia from 43 nursing homes. The QUALIDEM consists of nine subscales that were applied to a subsample of 378 people with mild to severe dementia and six consecutive subscales that were applied to a subsample of 256 people with very severe dementia. Scalability, internal consistency and distribution scores were calculated for each predefined subscale using the Mokken scale analysis.

RESULTS

In people with mild to severe dementia, seven subscales, care relationship, positive affect, negative affect, restless tense behavior, positive self-image, social relations and feeling at home, were scalable (0.31 ≤ H ≤ 0.65) and internally consistent (Rho ≥ 0.62). The subscales social isolation (H = 0.28) and having something to do (H = 0.18) were not scalable and exhibited insufficient reliability scores (Rho ≤ 0.53). For people with very severe dementia, five subscales, care relationship, positive affect, restless tense behavior, negative affect and social relations, were scalable (0.33 ≤ H ≤ 0.65), but only the first three of these subscales showed acceptable internal consistency (Rho 0.59 - 0.86). The subscale social isolation was not scalable (H = 0.20) and exhibited poor internal consistency (Rho = 0.42).

CONCLUSIONS

The results show an acceptable scalability and internal consistency for seven QUALIDEM subscales for people with mild to severe dementia and three subscales for people with very severe dementia. The subscales having something to do (mild to severe dementia), negative affect (very severe dementia), social relations (very severe dementia) and social isolation (both versions) produced unsatisfactory results and require revision.

The Chinese version of the cardiac depression scale: Mokken scaling

Background

Myocardial infarction is a major cause of death and morbidity in many countries, including China. The aim of this study was to analyse a Mandarin Chinese translation of the Cardiac Depression Scale for a hierarchy of items according to the criteria of Mokken scaling.

Findings

Data from 438 Chinese participants who completed the Chinese translation of the Cardiac Depression Scale were analysed using the Mokken scaling procedure and the 'R' statistical programme using the diagnostics available in these programmes. Correlations between Mandarin Chinese items and Chinese translations of the Hospital Anxiety and Depression Scale and the Beck Depression Inventory were also analysed. Fifteen items from the Mandarin Chinese Cardiac Depression Scale were retained in a weak but reliable Mokken scale; invariant item ordering was evident but of low accuracy and the Mokken scaled items of the Chinese Cardiac Depression Scale correlated with the Hospital Anxiety and Depression Scale and the Beck Depression Inventory.

Conclusions

Items from the Mandarin Chinese Cardiac Depression Scale form a Mokken scale and this offers further insight into how the items of the Cardiac Depression Scale relate to the measurement of depression in people with a myocardial infarction.

The Chinese version of the Myocardial Infarction Dimensional Assessment Scale (MIDAS): Mokken scaling

Background

Hierarchical scales are very useful in clinical practice due to their ability to discriminate precisely between individuals, and the original English version of the Myocardial Infarction Dimensional Assessment Scale has been shown to contain a hierarchy of items. The purpose of this study was to analyse a Mandarin Chinese translation of the Myocardial Infarction Dimensional Assessment Scale for a hierarchy of items according to the criteria of Mokken scaling. Data from 180 Chinese participants who completed the Chinese translation of the Myocardial Infarction Dimensional Assessment Scale were analysed using the Mokken Scaling Procedure and the 'R' statistical programme using the diagnostics available in these programmes. Correlation between Mandarin Chinese items and a Chinese translation of the Short Form (36) Health Survey was also analysed.

Findings

Fifteen items from the Mandarin Chinese Myocardial Infarction Dimensional Assessment Scale were retained in a strong and reliable Mokken scale; invariant item ordering was not evident and the Mokken scaled items of the Chinese Myocardial Infarction Dimensional Assessment Scale correlated with the Short Form (36) Health Survey.

Conclusions

Items from the Mandarin Chinese Myocardial Infarction Dimensional Assessment Scale form a Mokken scale and this offers further insight into how the items of the Myocardial Infarction Dimensional Assessment Scale relate to the measurement of health-related quality of life people with a myocardial infarction.

Item response theory: how Mokken scaling can be used in clinical practice

AIMS

To demonstrate the principles and application of Mokken scaling.

BACKGROUND

The history and development of Mokken scaling is described, some examples of applications are given, and some recent development of the method are summarised.

DESIGN

Secondary analysis of data obtained by cross-sectional survey methods, including self-report and observation.

METHODS

Data from the Edinburgh Feeding Evaluation in Dementia scale and the Townsend Functional Ability Scale were analysed using the Mokken scaling procedure within the 'R' statistical package. Specifically, invariant item ordering (the extent to which the order of the items in terms of difficulty was the same for all respondents whatever their total scale score) was studied.

RESULTS

The Edinburgh Feeding Evaluation in Dementia scale and the Townsend Functional Ability Scale showed no violations of invariant item ordering, although only the Townsend Functional Ability Scale showed a medium accuracy.

CONCLUSION

Mokken scaling is an established method for item response theory analysis with wide application in the social sciences. It provides psychometricians with an additional tool in the development of questionnaires and in the study of individuals and their responses to latent traits. Specifically, with regard to the analyses conducted in this study, the Edinburgh Feeding Evaluation in Dementia scale requires further development and study across different levels of severity of dementia and feeding difficulty.

RELEVANCE TO CLINICAL PRACTICE

Good scales are required for assessment in clinical practice and the present paper shows how a relatively recently developed method for analysing Mokken scales can contribute to this. The two scales used as examples for analysis are highly clinically relevant.

A stairway to heaven? Structure of the religious involvement inventory and spiritual well-being scale

Being religious or having spiritual beliefs has been linked to improved health and well-being in several empirical studies. Potential underlying mechanisms can be suggested by psychometrically reliable and valid indices. Two self-report measures of religiosity/spirituality were completed by a cohort of older adults: the Religious Involvement Inventory and the Spiritual Well-being Scale. Both were analyzed using principal components analysis and the Mokken scaling procedure. The latter technique examines whether items can be described as having a hierarchical structure. The results across techniques were comparable and hierarchical structures were discovered in the scales. Analysis of the hierarchy in the RII items suggested the latent trait assesses the extent to which an individual's belief in God influences their life. Examining scales with a range of psychometric techniques may give a better indication of the latent construct being assessed, particularly the hierarchies within these which may be of interest to those investigating religiosity-health associations.