Calibration of an item bank in 474 orthopedic patients using Rasch analysis for computer-adaptive assessment of anxiety

Psychometric evaluation of the Patient Assessment of Chronic Illness Care instrument using Item analysis according to the Rasch model

RATIONALE, AIMS AND OBJECTIVES

The Patient Assessment of Chronic Illness Care (PACIC) instrument assesses patient care in alignment with the chronic care model. The aim of the study was to comprehensively validate the PACIC using the Rasch model. A special focus was placed on the investigation of local dependence (LD), differential item functioning (DIF) and targeting.

METHOD

This secondary analysis utilized data of 760 patients with a diagnosis of diabetes who had participated in the Swiss CoDiab-VD cohort study. The psychometric properties of the French PACIC-version were evaluated using the Rasch model. DIF was investigated in relation to age, gender, education, year of recruitment into the CoDiab-VD cohort study, type of diabetes and whether patients got an injectable antidiabetic drug or not.

RESULTS

The initial analysis of the PACIC revealed poor fit to the Rasch model (χ² -p < 0.001) with response dependency being the most prominent problem. After combining the items into two testlets (testlet 1: Items 1-11; testlet 2: Items 12-20), good overall model fit was found (χ² -p = 0.77) as well as good reliability (Person Separation Index = 0.85) and targeting. DIF with regard to whether patients got an injectable antidiabetic drug or not was found for testlet 2. However, the size of this DIF was regarded as not being substantial.

CONCLUSION

The PACIC is a well-targeted, reliable unidimensional instrument to assess patient care in alignment with the chronic care model in patients with diabetes. It is free of substantial DIF. The PACIC-20 sum score can hence be used in clinical practice for individual diagnostic. For evaluation purposes like assessment of change or group evaluations, the usage of the interval-scale level person parameters is recommended as it permits using parametric statistical analyses and provides a more accurate picture about the actual amount of change.

Development of the German social attitude barriers and facilitators to participation-scales: an analysis according to the Rasch model

BACKGROUND

Social attitudes experienced by people with disabilities can strongly impact upon their health and quality of life. The extent to which social attitude measurement transcends specific cultures is unknown. Thus, the aim of the study was to develop German item banks to assess social attitude barriers and facilitators to participation and compare the construct definition with that developed in the United States.

METHODS

The American version of the two item banks assessing social attitudes that act as barriers and facilitators in persons with disabilities was translated into German and culturally adapted. The sample consisted of 410 in- and outpatients treated for spinal diseases at a German University Hospital. The psychometric properties of the resulting 53 items-item pool were evaluated using Rasch analysis. A special focus was placed on the investigation of unidimensionality, local independence, differential item functioning (DIF) and targeting. To evaluate convergent and divergent validity correlations with perceived social support, depression and pain interference were calculated.

RESULTS

Unlike the American version, both the barriers and facilitators item banks had to be divided into two subscales assessing attitudes that individuals with disabilities experience as being directed towards them (individual perception) or attitudes that respondents experience as being directed towards people with disabilities as a social group (societal perception). Four unidimensional scales were constructed. Fit to the Rasch model required item deletion and forming testlets to account for extensive local dependence. There was no evidence of DIF with regard to gender or age. Targeting of the subscales was moderate to good.

CONCLUSIONS

Results support a distinction between social attitudes at the individual and societal level, allowing a more specific assessment than is possible when this distinction is ignored.

Rehabilitation Through Physical Activity and Sport in Light of the International Classification of Functioning, Disability, and Health–Current Research Perspectives

The implementation of functioning by the World Health Organization (WHO) as the third global health indicator, along with mortality and morbidity, represents a promising advancement for a comprehensive assessment of international health systems and health strategies. The description of a person's health state operationalized by both biological and lived health via functioning provides a holistic picture of an individual's life situation and proved to be successful in building a framework for formulating therapy goals, achievable activities, and participational aspects against the background of an individual's life situation. Furthermore, improving an individual's functional ability and wellbeing could potentially affect the health indicators of morbidity and mortality and will be codable beyond the ICF in ICD-11. This methodological perspective emphasizes the use of ICF applications on the wider and narrower level of international rehabilitation systems and highlights the incorporation of the term functioning in rehabilitation through physical activity and sport. Current research perspectives in applying the ICF and functioning in clinical and rehabilitation practices are discussed and a current explorative study is presented, which applies the holistic orientation of functioning and the biopsychosocial model to the specific case by an individualized sports coaching intervention in rehabilitation. Subsequently, a unifying ICF- oriented language in rehabilitation is considered as a powerful foundation for a consistent international research strategy concerning increased international collaborations and future research perspectives.

[Quality-oriented facility selection in the rehabilitation of the German pension insurance]

According to Sixth Book of the Social Code (SGB VI), the German Pension Insurance (GPI) has the mandate to maintain or restore the employability of its insured persons. In order to achieve this goal, the GPI offers its insurees rehabilitation benefits. These are, on the one hand, services for prevention and medical rehabilitation (rehab) and, on the other hand, services for return-to-work or stay-at-work, respectively. In order to fulfill this mandate in the best possible way, in 1990 the GPI introduced instruments of external quality assurance (EQS) with scientific support. The system was firmly established in 1997. Since then, all rehab facilities owned and managed by the GPI are obliged to participate in the EQS system.Over the years, a large number of instruments and procedures have been developed that can map various aspects of quality as structure, process, and outcome. Until 2017, results of the EQS had no influence on the cooperation between the GPI and service providers. With the binding decision of the Federal Executive Board of the GPI in 2017, for the first time the GPI linked the allocation of rehab services for specific patients with the results of EQS. On this basis - confirmed by article 3 of the Digital Pension Overview Act - new paths are being taken. As part of the technically supported selection of a suitable facility for insured persons, quality should systematically and transparently acquire special importance and be consistently taken into account when occupying rehab facilities.This article gives an overview of the development of the proved and tested instruments of rehab quality assurance (QA), their current application, and an outlook on the rehab QA of the future.