Exploring the aggregation of four functional measures in a population of older adults with joint pain and comorbidity

Measuring perceived fitness interdependence between humans and non-humans

Conservation ethics (i.e. moral concern for non-human organisms) are widespread, but we lack a comprehensive explanation for why people care about other species at all, and why they express strong moral concern for some species but not others. Recent theory suggests that conservation ethics might be rooted in cooperation between humans and members of other species. Building on central predictions of this eco-evolutionary theory, we conducted an online study (N = 651) and exploratory factor analysis to develop two scales that independently measure perceived fitness interdependence (PFI) and conservation ethics. The PFI scale measures perceived shared fate as a proximate indicator of human fitness interdependence with non-human organisms (i.e. the degree to which humans and other organisms influence each other's evolutionary success, that is, survival and reproduction). We designed the conservation ethics scale to measure moral beliefs and attitudes regarding those organisms. Both scales are composed of two factors and demonstrate good internal reliability. By combining insights from various branches of the evolutionary human sciences, including evolutionary anthropology, evolutionary psychology and human behavioural ecology, we offer empirical tools to investigate eco-evolutionary foundations of conservation ethics and behaviour.

Health-related quality of life in Iranian adolescents: a psychometric evaluation of the self-report form of the PedsQL 4.0 and an investigation of gender and age differences

Background

Research on the psychometric properties of the Persian self-report form of the Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0) in adolescents has several gaps (e.g., convergent validity) that limit its clinical application and therefore the cross-cultural impact of this measure. This study aimed at investigating the psychometric properties of the PedsQL 4.0 and the effects of gender and age on quality of life in Iranian adolescents.

Method

The PedsQL 4.0 was administered to 326 adolescents (12–17 years). A subsample of 115 adolescents completed the scale two weeks after the first assessment. Confirmatory Factor Analysis (CFA), correlation of the PedsQL 4.0 with the Weiss Functional Impairment Rating Scale-Self-report (WFIRS-S), and Item Response Theory (IRT) analysis were conducted to examine validity. Cronbach’s alpha, McDonald’s Omega, and Intra class correlation (ICC) were calculated as well to examine reliability. Gender and age effects were also evaluated.

Results

Internal consistency and test–retest reliability of the total PedsQL 4.0 scale was .92 and .87, respectively. The PedsQL 4.0 scores showed negative moderate to strong correlations with the WFIRS-S total scale. The four-factor model of the PedsQL 4.0 was not fully supported by the CFA—the root mean square error of approximation and the comparative fit index showed a mediocre and poor fit, respectively. IRT analysis indicated that all items of the PedsQL 4.0 fit with the scale and most of them showed good discrimination. The items and total scale provided more information in the lower levels of the latent trait. Males showed significantly higher scores than females in physical and emotional functioning, psychosocial health, and total scale. Adolescents with lower ages showed better quality of life than those with higher ages in all scores of the PedsQL 4.0.

Conclusion

The PedsQL 4.0 showed good psychometric properties with regard to internal consistency, test–retest reliability, and convergent validity in Iranian adolescents, which supports its use in clinical settings among Persian-speaking adolescents. However, factor structure according to our CFA indicates that future work should address how to improve fit. In addition, studies that include PedsQL 4.0 should consider gender and age effects were reported.

The Minimal Eating Observation Form-II Danish Version: Psychometric and Metrological Aspects

BACKGROUND AND PURPOSE

The Minimal Eating Observation Form - II (MEOF-II) is a screening and research tool for eating difficulties. We assess psychometric and metrological aspects of the Danish version of the tool.

METHODS

This study includes MEOF-II data from 302 acute geriatric patients. Analyses were based on Classical Test Theory and Rasch Model Analysis.

RESULTS

51.3% of the patients had eating difficulties. The MEOFII items belonged to one higher order factor, and three lower level factors: deglutition; ingestion; and energy/appetite. The hierarchical structure of the items was revealed. The MEOF-II had a good fit with Rasch model expectations.

CONCLUSION

The study provides support for the reliability and validity of the Danish version of the MEOF-II. MEOF-II total and subscale scores are reliable and valid for use in nursing practice and research.

The Minimal Eating Observation Form-Version II Revisited: Validity and Reliability

BACKGROUND AND PURPOSE

The Minimal Eating Observation Form-Version II (MEOF-II) is a screening and research tool for eating difficulties. Here we assess the psychometric properties of the tool.

METHODS

Cross-sectional MEOF-II data, n = 5,956 persons (nursing home residents [n = 3,087]; in-hospital patients [n = 1,490]; mean age 76.9; 61% women). Data was analyzed taking account of the dichotomous nature of item-level data, that is, based on tetrachoric correlations.

RESULTS

The MEOF-II items (n = 9) belonged to one higher order unidimensional factor (61.7% explained variance, omega 0.92), and three lower level factors, with three items each (92.9% explained variance, omega 0.83-0.88): deglutition; ingestion; and energy/appetite.

CONCLUSION

The study provides support for the reliability and validity of the MEOF-II total scale and subscales, and the findings are in line with previous studies.

Exploring the measurement properties of the osteopathy clinical teaching questionnaire using Rasch analysis

Background

Clinical teaching evaluations are common in health profession education programs to ensure students are receiving a quality clinical education experience. Questionnaires students use to evaluate their clinical teachers have been developed in professions such as medicine and nursing. The development of a questionnaire that is specifically for the osteopathy on-campus, student-led clinic environment is warranted. Previous work developed the 30-item Osteopathy Clinical Teaching Questionnaire. The current study utilised Rasch analysis to investigate the construct validity of the Osteopathy Clinical Teaching Questionnaire and provide evidence for the validity argument through fit to the Rasch model.

Methods

Senior osteopathy students at four institutions in Australia, New Zealand and the United Kingdom rated their clinical teachers using the Osteopathy Clinical Teaching Questionnaire. Three hundred and ninety-nine valid responses were received and the data were evaluated for fit to the Rasch model. Reliability estimations (Cronbach's alpha and McDonald's omega) were also evaluated for the final model.

Results

The initial analysis demonstrated the data did not fit the Rasch model. Accordingly, modifications to the questionnaire were made including removing items, removing person responses, and rescoring one item. The final model contained 12 items and fit to the Rasch model was adequate. Support for unidimensionality was demonstrated through both the Principal Components Analysis/t-test, and the Cronbach's alpha and McDonald's omega reliability estimates. Analysis of the questionnaire using McDonald's omega hierarchical supported a general factor (quality of clinical teaching in osteopathy).

Conclusion

The evidence for unidimensionality and the presence of a general factor support the calculation of a total score for the questionnaire as a sufficient statistic. Further work is now required to investigate the reliability of the 12-item Osteopathy Clinical Teaching Questionnaire to provide evidence for the validity argument.

A Mokken scale analysis of the peer physical examination questionnaire

Background

Peer physical examination (PPE) is a teaching and learning strategy utilised in most health profession education programs. Perceptions of participating in PPE have been described in the literature, focusing on areas of the body students are willing, or unwilling, to examine. A small number of questionnaires exist to evaluate these perceptions, however none have described the measurement properties that may allow them to be used longitudinally. The present study undertook a Mokken scale analysis of the Peer Physical Examination Questionnaire (PPEQ) to evaluate its dimensionality and structure when used with Australian osteopathy students.

Methods

Students enrolled in Year 1 of the osteopathy programs at Victoria University (Melbourne, Australia) and Southern Cross University (Lismore, Australia) were invited to complete the PPEQ prior to their first practical skills examination class. R, an open-source statistics program, was used to generate the descriptive statistics and perform a Mokken scale analysis. Mokken scale analysis is a non-parametric item response theory approach that is used to cluster items measuring a latent construct.

Results

Initial analysis suggested the PPEQ did not form a single scale. Further analysis identified three subscales: ‘comfort’, ‘concern’, and ‘professionalism and education’. The properties of each subscale suggested they were unidimensional with variable internal structures. The ‘comfort’ subscale was the strongest of the three identified. All subscales demonstrated acceptable reliability estimation statistics (McDonald’s omega > 0.75) supporting the calculation of a sum score for each subscale.

Conclusion

The subscales identified are consistent with the literature. The ‘comfort’ subscale may be useful to longitudinally evaluate student perceptions of PPE. Further research is required to evaluate changes with PPE and the utility of the questionnaire with other health profession education programs.

A Mokken analysis of the literacy in musculoskeletal problems questionnaire

BACKGROUND

Limited health literacy is known to impact on medication adherence, hospital readmission and potentially poorer health outcomes. The literature on the health literacy of those with musculoskeletal conditions suggests greater functional limitations and increased pain levels. There are a number of measures of health literacy. One that specifically relates to musculoskeletal complaints is the Literacy in Musculoskeletal Problems (LiMP) questionnaire. The LiMP contains 9 multiple choice items that cover anatomy, musculoskeletal conditions and the diagnosis of musculoskeletal complaints. The aim of the study was to evaluate the dimensionality and internal structure of the LiMP in patients attending for osteopathy care at a student-led clinic, as a potential measure of musculoskeletal health literacy.

METHOD

Three hundred and sixty-one (n = 361) new patients attending the Victoria University Osteopathy Clinic completed the LiMP and a demographic and health information questionnaire prior to their initial consultation. Mokken scale analysis, a nonparametric item response theory approach, was used to evaluate the dimensionality and structure of the LiMP in this population, to ascertain whether the questionnaire was measuring a single latent construct - musculoskeletal health literacy. McDonald's omega and Cronbach's alpha were calculated as the reliability estimations. The relationship between the LiMP and a single item screen of health literacy was also undertaken.

RESULTS

The 9 items on the LiMP did not form a Mokken scale and the reliability estimations were below an acceptable level (alpha and omega <0.45). LiMP items 5 and 8 were more likely to be answered correctly by those with higher health literacy (p < 0.05), however the effect sizes were small (<0.20).

CONCLUSION

Calculation of a total score for the LiMP, as advocated by the original authors, is not supported based on data in the present study. Further research is required to explore the relationship of the LiMP items to demographic and clinical data, and to other broader measures of health literacy. Further research may also develop a health literacy measure that is specific to patients seeking manual therapy care for musculoskeletal complaints.

[A way of helping "Mr. Minotaur" and "Ms. Ariadne" to exit from the multiple morbidity labyrinth: the "master problems"]

Multiple morbidity seems to be "infinite" and so is not easy to make useful decisions. A new concept is introduced: the "master problems", as a qualitative method to facilitate the exit from this maze of multiple morbidity. Metaphors from the art world have been used to teach this concept. These "master problems" generally remain hidden and can only "unravel" between the interstices of multiple morbidity, when the details of the system that defines the problem are explained. A problem with "energy" or a "master problem" is complex, multiple and dramatic or theatrical--everything in the clinical history history make us look into that particular question. It is what gives us a blow to the stomach, which causes our hearts to beat faster, that moves us on many levels, which has a high "density of emotions", human elements, social symbols, and opens solutions in a patient.