A comparison of traditional and Rasch cut points for assessing clinically important change in health-related quality of life among patients with asthma
A comparison of traditional and Rasch cut points for assessing clinically important change in health-related quality of life among patients with asthma
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DOI：
10.1007/s11136-006-0036-6
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发表时间：
2006-12-01
影响因子：
3.5
通讯作者：
Wolinsky, Fredric D.
中科院分区：
文献类型：
--
作者：
Metz, Stacie M.;Wyrwich, Kathleen W.;Wolinsky, Fredric D.
工作背景：患者感知的健康相关生活质量（HRQoL）领域的变化通常使用15分患者过渡评定量表进行分类。然而，在该量表上，传统的变化水平（轻微（-1，0或1），最小（2，3或-2，-3），中等（4，5或-4，-5）和大（6，7或-6，-7））是任意定义的，最初假设与改善相关的变化与下降相同。目的：在评估哮喘特异性HRQoL的临床重要变化时，比较传统和Rasch部分信用模型推导的临界点和每种变化类别的平均变化。研究方法：我们的样本包括396名哮喘门诊患者，他们每两个月完成一次哮喘生活质量问卷和过渡评定项目的电话访谈，参与时间超过1年。我们采用项目反应理论在一种新的方法来确定特定领域的HRQoL变化数据和转换评级的切入点。在确定了过渡评级锚上最小、中等和较大差异的自然分界点后，我们计算了两种过渡评级分类方法的改善和下降的变化分类下的平均变化。结果如下：虽然传统和Rasch分类的小，中，大的变化略有不同，并显示改善和下降之间缺乏对称性，几乎所有的平均变化之间的分类方法是可比的。结论：在这项研究中，传统的转换评级切点仍然适用于评估门诊哮喘患者的HRQoL临床意义。
Background: Patient-perceived change in health-related quality of life (HRQoL) domains has often been classified using a 15-point patient transition rating scale. However, traditional change levels of trivial (-1, 0, or 1), minimal (2, 3 or -2, -3), moderate (4, 5 or -4, -5) and large (6, 7 or -6, -7) on this scale have been arbitrarily defined and originally assumed that change related to an improvement was the same as that for a decline. Objective: To compare traditional and Rasch partial credit model-derived cut points and the mean changes for each change categorization when assessing clinically important change in asthma-specific HRQoL. Methods: Our sample included 396 asthmatic outpatients who completed bimonthly telephone interviews on the Asthma Quality of Life Questionnaire and transition rating items over 1 year of participation. We employed item response theory in a novel approach to identify cut points on domain-specific HRQoL change data and transition ratings. After determining natural cut points for minimal, moderate, and large differences on the transition rating anchor, we calculated mean changes under change categorizations for both improvements and declines for the two transition rating classification approaches. Results: Although traditional and Rasch categorizations for small, moderate, and large changes slightly differed and displayed a lack of symmetry between improvements and declines, nearly all mean changes between classification approaches were comparable. Conclusions: In this study, traditional transition rating cut points remain suitable to assess HRQoL clinical significance in outpatients with asthma.