Improving the Precision of the Glasgow Outcome Scale-Extended Using Item Response Theory: A TRACK-TBI Study.
Improving the Precision of the Glasgow Outcome Scale-Extended Using Item Response Theory: A TRACK-TBI Study.
复制标题
使用项目反应理论提高格拉斯哥结果量表扩展的精度：TRACK-TBI 研究。
DOI：
10.1089/neu.2021.0421
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发表时间：
2022
影响因子：
4.2
通讯作者：
TRACK-TBIInvestigators
中科院分区：
文献类型：
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作者：
Magnus,BrookeE;Balsis,Steve;Giacino,JosephT;McCrea,MichaelA;Temkin,NancyR;Whyte,John;Manley,GeoffreyT;Nelson,LindsayD;TRACK-TBIInvestigators
格拉斯哥结局量表扩展版（GOSE）是一种功能性结局指标，旨在将创伤性脑损伤（TBI）患者分为损伤相关残疾的8个广泛级别之一。这种简单性并不总是最佳的，特别是当需要对个体的损伤恢复进行更细粒度的评估时。然而，GOSE通常使用多问题访谈进行评估，该访谈包含的信息比GOSE评分所反映的信息更丰富。使用来自多中心转化研究和TBI临床知识（TRACK-TBI）研究（N = 1544）的数据，我们使用项目反应理论（IRT）来评估使用IRT对GOSE进行重新评分是否可以产生更精确的损伤相关功能限制指数。我们将IRT模型与受伤后三个月收集的GOSE访谈反应相匹配。每个参与者的功能限制水平估计模型（GOSE-IRT）和IRT为基础的和标准（GOSE-Ordinal）的分数之间进行了比较。IRT评分产生了141个可能的评分（与此样本中GOSE评分在2和8之间的个体的7个GOSE-序数评分相比）。此外，GOSE-IRT评分与TBI相关症状、心理症状和生活质量的测量结果显著相关。我们的研究结果表明，使用IRT对GOSE访谈进行重新评分，可以对损伤相关的功能限制进行更细粒度、更有意义的测量，同时不会增加额外的受访者或检查者负担。该技术可用于许多应用，例如旨在检测小治疗效果的临床试验，以及需要最大化统计效率的小规模研究。
The Glasgow Outcome Scale-Extended (GOSE) is a functional outcome measure intended to place individuals with traumatic brain injury (TBI) into one of eight broad levels of injury-related disability. This simplicity is not always optimal, particularly when more granular assessment of individuals’ injury recovery is desired. The GOSE, however, is customarily assessed using a multi-question interview that contains richer information than is reflected in the GOSE score. Using data from the multi-center Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study (N = 1544), we used item response theory (IRT) to evaluate whether rescoring the GOSE using IRT, which posits that a continuous latent variable (disability) underlies responses, can yield a more precise index of injury-related functional limitations. We fit IRT models to GOSE interview responses collected at three months post-injury. Each participant's level of functional limitation was estimated from the model (GOSE-IRT) and comparisons were made between IRT-based and standard (GOSE-Ordinal) scores. The IRT scoring resulted in 141 possible scores (vs. 7 GOSE-Ordinal scores in this sample of individuals with GOSE scores ranging between 2 and 8). Moreover, GOSE-IRT scores were significantly more strongly associated with measures of TBI-related symptoms, psychological symptoms, and quality of life. Our findings demonstrate that rescoring the GOSE interview using IRT yields more granular, meaningful measurement of injury-related functional limitations, while adding no additional respondent or examiner burden. This technique may have utility for many applications, such as clinical trials aiming to detect small treatment effects, and small-scale studies that need to maximize statistical efficiency.