Benjamin D. Schalet

Multidimensional Structure of the Hypomanic Personality Scale.

The structure of the Hypomanic Personality Scale was explored in a sample of young adults (N = 884); resulting structures were validated on subsamples with measures of personality traits, internalizing symptoms, and externalizing behaviors. Hierarchical cluster analysis and estimates of general factor saturation suggested the presence of a weak general factor, as well as 3 subordinate clusters. The 3-cluster subscales (Social Vitality, Mood Volatility, and Excitement) were moderately correlated but conceptually distinct and were correlated in opposing patterns with a range of personality and psychopathology measures. Results show that cluster subscales suppress total score associations with validity measures. Recommendations are made to analyze Hypomanic Personality Scale data by subscale, and theoretical implications are discussed.

Creating meaningful cut-scores for Neuro-QOL measures of fatigue, physical functioning, and sleep disturbance using standard setting with patients and providers

PurposeTo establish clinically relevant classifications of health outcome scores for four Neuro-QOL measures (lower extremity function, upper extremity function, fatigue, and sleep disturbance).MethodsWe employed a modified educational standard-setting methodology to identify cut-scores for symptom severity. Clinical vignettes were developed to represent graduated levels of symptom severity. A clinician panel and a panel of persons with multiple sclerosis (PwMS) were recruited, and, in separate, 1-day meetings, the panelists identified adjacent vignettes they judged to represent the threshold between two levels of severity for a given domain (e.g., threshold between a vignette that indicated “no problems” with sleep and the adjacent one that represented “mild problems” with sleep). Working independently, each panel (PwMS and clinicians) reached consensus on its recommended thresholds for each of the four targeted measures. Cut-scores were defined as the mean location for each pair of threshold vignettes.ResultsPwMS and clinician panels derived identical thresholds for severity levels of lower extremity function and sleep disturbance, but slightly different ones for upper extremity function and fatigue. In every case of divergence, PwMS set higher thresholds for more severe classifications of symptoms (by 0.5 SDs) than did clinicians.ConclusionsThe modified bookmarking method is effective for defining thresholds for symptom severity based on self-reported outcome scores and consensus judgments. Derived cut-scores and severity levels provide an interpretative context for Neuro-QOL scores. Future studies should explore whether these findings can be replicated and evaluate the validity of the classifications compared to external criteria.

Establishing a Common Metric for Physical Function: Linking the HAQ-DI and SF-36 PF Subscale to PROMIS® Physical Function

ABSTRACTBACKGROUNDPhysical function (PF) is a common health concept measured in clinical trials and clinical care. It is measured with different instruments that are not directly comparable, making comparative effectiveness research (CER) challenging when PF is the outcome of interest.OBJECTIVEOur goal was to establish a common reporting metric, so that scores on commonly used physical function measures can be converted into PROMIS scores.DESIGNFollowing a single-sample linking design, all participants completed items from the NIH Patient Reported Outcomes Measurement Information System (PROMIS®) Physical Function (PROMIS PF) item bank and at least one other commonly used “legacy” measure: the Health Assessment Questionnaire (HAQ) or the Short Form–36 physical function ten-item PF scale (SF-36 PF). A common metric was created using analyses based on item response theory (IRT), producing score cross-walk tables.PARTICIPANTSParticipants (N = 733) were part of an internet panel, many of whom reported one or more chronic health conditions.MAIN MEASURESPROMIS PF, SF-36 PF, and the HAQ–Disability Index (HAQ-DI).RESULTSOur results supported the hypothesis that all three scales measure essentially the same concept. Cross-walk tables for use in CER are therefore justified.CONCLUSIONSHAQ-DI and SF-36 PF results can be expressed on the PROMIS PF metric for the purposes of CER and other efforts to compare PF results across studies that utilize any one of these three measures. Clinicians seeking to incorporate PROs into their clinics can collect patient data on any one of these three instruments and estimate the equivalent on the other two.

PROMIS ® -29 v2.0 profile physical and mental health summary scores

PurposeThe PROMIS-29 v2.0 profile assesses pain intensity using a single 0–10 numeric rating item and seven health domains (physical function, fatigue, pain interference, depressive symptoms, anxiety, ability to participate in social roles and activities, and sleep disturbance) using four items per domain. This paper describes the development of physical and mental health summary scores for the PROMIS-29 v2.0.MethodWe conducted factor analyses of PROMIS-29 scales on data collected from two internet panels (n = 3000 and 2000).ResultsConfirmatory factor analyses provided support for a physical health factor defined by physical function, pain (interference and intensity), and ability to participate in social roles and activities, and a mental health factor defined primarily by emotional distress (anxiety and depressive symptoms). Reliabilities for these two summary scores were 0.98 (physical health) and 0.97 (mental health). Correlations of the PROMIS-29 v2.0 physical and mental health summary scores with chronic conditions and other health-related quality of life measures were consistent with a priori hypotheses.ConclusionsThis study develops and provides preliminary evidence supporting the reliability and validity of PROMIS-29 v2.0 physical and mental health summary scores that can be used in future studies to assess impacts of health care interventions and track changes in health over time. Further evaluation of these and alternative summary measures is recommended.

The impact of events scale: a comparison of frequency versus severity approaches to measuring cancer-specific distress

The Impact of Events Scale (IES) is one of the most widely used measures of event‐specific distress. The IES assesses the frequency with which respondents experience intrusive thoughts and avoidant behaviors over the past week. Our aim is to demonstrate the benefit of a severity‐based measurement approach of the IES compared with a frequency‐based measurement approach.

Physical function metric over measure: An illustration with the Patient‐Reported Outcomes Measurement Information System (PROMIS) and the Functional Assessment of Cancer Therapy (FACT)

Measuring patient‐reported outcomes (PROs) is becoming an integral component of quality improvement initiatives, clinical care, and research studies in cancer, including comparative effectiveness research. However, the number of PROs limits comparability across studies. Herein, the authors attempted to link the Functional Assessment of Cancer Therapy‐General Physical Well‐Being (FACT‐G PWB) subscale with the Patient‐Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) calibrated item bank. The also sought to augment a subset of the conceptually most similar FACT‐G PWB items with PROMIS PF items to improve the linking.

Motor-free composites from the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) for people with disabilities

Purpose/Objective: The National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) includes a group of brief measures (i.e., 30 min) designed to assess language, processing speed, working memory, episodic memory, and executive functioning. These subtests can be combined to create composite scores that reflect fluid and crystallized cognition, as well as overall cognition. The battery is of limited utility with individuals who have impaired upper extremity motor functioning. This manuscript examines the accuracy of the Oral Symbol Digit Modalities Test as a substitute for the Pattern Comparison Processing Speed Test for computing motor-free composite scores. Research Method/Design: Individuals with spinal cord injury (SCI; n = 188), traumatic brain injury (TBI; n = 159), or stroke (n = 180) completed the NIHTB-CB. We used the Oral Symbol Digit Modalities Test to create a Motor-Free Pattern Comparison score; this was used to create revised, Motor-Free Composite scores for Fluid Cognition and Overall Cognition. Results: Although there were statistically significant overall differences between the two Fluid and Overall Cognition composite scores for some of the clinical groups (scores based on the motor-free approach were significantly higher than the original score), these differences were small and partly because of overclassification of impaired processing speed in participants with motor impairment. There was good to substantial agreement with regard to “impairment” classification between the two sets of Original and Motor-Free composite scores. Conclusions/Implications: Although the Motor-Free scores are not a perfect match for the Original Composite scores, they provide a reliable and valid way to examine overall and fluid cognition in individuals with upper extremity motor impairments.