Better assessment of physical function: item improvement is neglected but essential.
Better assessment of physical function: item improvement is neglected but essential.
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DOI：
10.1186/ar2890
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发表时间：
2009
影响因子：
4.9
通讯作者：
Ware JE Jr
中科院分区：
文献类型：
--
作者：
Bruce B;Fries JF;Ambrosini D;Lingala B;Gandek B;Rose M;Ware JE Jr
身体功能是风湿病患者报告结果(PRO)评估的关键组成部分。现代心理测量学方法，如项目反应理论(IRT)和计算机化的适应性测验，可以显著提高项目水平的测量精度。我们提出了开发患者报告结果测量信息系统(PROIS)身体功能题库的定性和定量项目评估流程。这个过程是循序渐进的：我们进行了广泛的搜索，以确定现有的物理功能项目，然后对项目库进行分类并有选择地减少项目库。我们通过专家和患者调查、焦点小组和认知访谈对保留项目的内容、清晰度、相关性和理解力、阅读水平和翻译简易性进行了评估。然后使用经典测验理论和项目反应理论对项目进行评估，使用验证性因素分析估计项目参数，并使用分级反应模型进行参数估计。保留20份遗留(原)健康评估问卷残障指数(HAQ-DI)和10个SF-36‘S PF-10条目进行比较。受试者来自类风湿性关节炎、骨关节炎和健康老龄化队列(n=1100)，以及21,133名全国互联网样本。我们确定了1,860件物品。经过定性和定量评价，124个新开发的PROMIS项目组成了PROMIS题库，其中包括符合IRT模型假设的修订后的遗留项目。结果显示，最清楚和最容易理解的项目是简单、现在时和直截了当。基本的任务(如穿衣)比复杂的任务(如跳舞)更相关、更重要。具有五个反应选项的修订后的HAQ-DI和PF-10条目的条目信息含量高于具有较少反应选项的可比原始遗留条目。IRT分析表明，物理功能域满足单维度的一般标准，单因素、两因素、三因素和四因素模型具有可比较的模型拟合。测试数据集中各因素之间的相关系数为0.90。项目改进必须是改进结果评估的努力的基础。在PROMIS身体机能题库中，明确的、个人重要的和相关的、能力框架的项目在PROIS评估中表现良好。它们将受益于在不同的临床群体中对更广泛的风湿性疾病的进一步研究和应用，包括那些处于身体功能极端的群体，以及不同的给药模式。
Physical function is a key component of patient-reported outcome (PRO) assessment in rheumatology. Modern psychometric methods, such as Item Response Theory (IRT) and Computerized Adaptive Testing, can materially improve measurement precision at the item level. We present the qualitative and quantitative item-evaluation process for developing the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function item bank. The process was stepwise: we searched extensively to identify extant Physical Function items and then classified and selectively reduced the item pool. We evaluated retained items for content, clarity, relevance and comprehension, reading level, and translation ease by experts and patient surveys, focus groups, and cognitive interviews. We then assessed items by using classic test theory and IRT, used confirmatory factor analyses to estimate item parameters, and graded response modeling for parameter estimation. We retained the 20 Legacy (original) Health Assessment Questionnaire Disability Index (HAQ-DI) and the 10 SF-36's PF-10 items for comparison. Subjects were from rheumatoid arthritis, osteoarthritis, and healthy aging cohorts (n = 1,100) and a national Internet sample of 21,133 subjects. We identified 1,860 items. After qualitative and quantitative evaluation, 124 newly developed PROMIS items composed the PROMIS item bank, which included revised Legacy items with good fit that met IRT model assumptions. Results showed that the clearest and best-understood items were simple, in the present tense, and straightforward. Basic tasks (like dressing) were more relevant and important versus complex ones (like dancing). Revised HAQ-DI and PF-10 items with five response options had higher item-information content than did comparable original Legacy items with fewer response options. IRT analyses showed that the Physical Function domain satisfied general criteria for unidimensionality with one-, two-, three-, and four-factor models having comparable model fits. Correlations between factors in the test data sets were > 0.90. Item improvement must underlie attempts to improve outcome assessment. The clear, personally important and relevant, ability-framed items in the PROMIS Physical Function item bank perform well in PRO assessment. They will benefit from further study and application in a wider variety of rheumatic diseases in diverse clinical groups, including those at the extremes of physical functioning, and in different administration modes.
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影响因子：
7.2
作者：
Rose, M.;Bjomer, J. B.;Ware, J. E.
通讯作者：
Ware, J. E.
影响因子：
--
作者：
Fries, JF;Singh, G;Hubert, H
通讯作者：
Hubert, H
影响因子：
3
作者：
Reeve, Bryce B.;Hays, Ron D.;Cella, David
通讯作者：
Cella, David
影响因子：
3
作者：
Cella, David;Yount, Susan;Rose, Mattias
通讯作者：
Rose, Mattias
影响因子：
3.5
作者：
Fliege, H;Becker, J;Rose, M
通讯作者：
Rose, M