Chi-Wen Chien

Measurement properties of fine motor scale of Peabody developmental motor scales-second edition: a Rasch analysis.

Chien CW, Bond TG: Measurement properties of fine motor scale of peabody developmental motor scales-second edition: A Rasch analysis. Am J Phys Med Rehabil 2009;88:376–386. Objective:To investigate the measurement properties (including rating scale performance, unidimensionality, and differential item functioning) of the fine motor scale of the Peabody Developmental Motor Scales-Second Edition in children, by using the Rasch analysis. Design:A total of 419 children (including 342 typically developing children and 77 children with fine motor delays or difficulties) were recruited in Taiwan for this prospective study. Each child was evaluated with the Peabody Developmental Motor Scales-Second Edition that consists of 26-item grasping and 72-item visual-motor integration subtests. Partial credit Rasch analysis was used for all analyses. Results:The Rasch analysis indicated that middle rating category for 19 grasping and 52 visual-motor integration items could be collapsed to allow only dichotomous response categories. Item fit analysis and principal component analysis suggested that the unidimensionality of the grasping and visual-motor integration subtests could be achieved after removal of two grasping and eight visual-motor integration misfitting items. All but 13 items in the composite scale could form a unidimensional construct of overall fine motor ability. Furthermore, only a few items were found to show differential item functioning across sex (ten items) or fine motor status (seven items). However, significant ceiling effects were found in the Peabody Developmental Motor Scales-Second Edition subtests and composite scale when applied to these typically developing children. Conclusions:Our results suggest grounds for the revision of the Peabody Developmental Motor Scales-Second Edition in a subsequent edition. Simplifying the rating scales and reducing the misfitting items in the subtests and composite scales might result in a unidimensional assessment of children’s fine motor ability. Clinicians and researchers could use the reduced Peabody Developmental Motor Scales-Second Edition as a criterion-referenced outcome measure to document changes; however, further work is needed to reduce the ceiling effects.

Comparative Content Review of Children's Participation Measures Using the International Classification of Functioning, Disability and Health–Children and Youth

OBJECTIVE To evaluate to what extent instruments that intend to measure childrens participation actually do so, and to what extent their items can be classified according to the International Classification of Functioning, Disability and Health-Children and Youth (ICF-CY). DATA SOURCES A systematic search was conducted in MEDLINE, CINAHL, PsycINFO, ERIC, and EMBASE and was limited to the period between January 2000 and May 2011. The search terms of participation, outcome measure, and children were used to identify potential childrens participation measures. DATA SELECTION Instruments were included if they (1) evaluated childrens participation based on assessment purpose; (2) were suitable for use with children aged 2 to 12 years; (3) were generic assessments that could be used with a range of disabilities; and (4) involved self-report, proxy report, or interview administrations. DATA EXTRACTION Instruments were obtained from identified full-text articles and were evaluated for inclusion through group discussion. Two researchers further independently reviewed each included instrument to determine which of the items measured participation based on a contemporary definition. These items were also classified using the ICF-CY linking rules to reflect each instruments content coverage. DATA SYNTHESIS Sixteen instruments were identified with 11 found to have more than half of their items measuring participation, but only the School Function Assessment-Participation section comprised 100% participation items. The participation items in each instrument captured between 3 and 9 ICF-CY Activities and Participation domains. Only the Child and Adolescent Scale of Participation and the Participation and Environment Measure for Children and Youth covered all domains. Among the ICF-CY Activities and Participation domains, the interpersonal interactions and relationships domain was addressed the least. CONCLUSIONS This review revealed differences in the inclusion of participation items in existing childrens participation measures and their classification according to the ICF-CY. These differences need to be considered when selecting an instrument.

Developing a Short Form of the Postural Assessment Scale for People With Stroke

Objective: To develop a Short Form of Postural Assessment Scale for Stroke patients (SFPASS) with sound psychometric properties (including reliability, validity, and responsiveness). Methods. This study consisted of 2 parts: developing the SFPASS and cross-validation. In the 1st part, 287 people with stroke were evaluated with the PASS at 14- and 30-day post-stroke intervals. The authors reduced the number of test items that constitute the PASS by more than half (i.e., making 5-, 6-, and 7-item sets) and simplified the scoring system (i.e., collapsing the 4-level scale in the original PASS into a 3-level scale [PASS-3L]), making both 4-L and 3-L versions available. Thus, a total of 6 SFPASSs were generated. In addition, 2 external criteria, the Barthel activities of daily living index and the Fugl-Meyer motor test, were used to examine the validity of the 6 SFPASSs. The psychometric properties of the new 6 SFPASSs were compared with each other as well as with those of the original PASS to determine which scale outperformed the others. In the 2nd part of the study, the authors cross-validated the best SFPASS using another independent sample of 179 people with stroke. Results. All 6 SFPASSs demonstrated good reliability, validity, and responsiveness. However, the Bland-Altman plots showed that only the 5-item PASS-3L demonstrated no systematic trend between the difference and mean score of the 5-item PASS-3L and the original PASS. The 5-item PASS-3L also had psychometric properties similar to those of the original PASS, as demonstrated in a cross-validation sample. Conclusion. The authors’ results provide strong evidence that the 5-item PASS-3L has sound psycho-metric properties in people with stroke. The 5-item PASS-3L is simple and fast to administer and is thus recommended.

Rasch-based scoring offered more precision in differentiating patient groups in measuring upper limb function

OBJECTIVE To compare the discriminatory ability of Rasch-based and summative scoring in the context of assessing upper limb function of patients with stroke. STUDY DESIGN AND SETTING Data were from a cohort study of 497 adults with stroke undergoing physiotherapy. Upper limb function was assessed at admission and discharge using the upper limb subscale of the Motor Assessment Scale (UL-MAS). Rasch analysis was used to transform raw UL-MAS scores into interval measures. A relative precision (RP) index was used to differentiate patients by discharge destination. RESULTS The analysis confirmed the unidimensional structure of UL-MAS at both admission and discharge and demonstrated the adequate fit of the items. The RP index favored the Rasch-based scoring over the summative scoring in differentiating between the two patient groups, with significant gains in precision at admission (15%) and discharge (11%). When examining patients in the upper or lower quartile of UL-MAS, the gains in precision were statistically significant in favor of the Rasch-based scoring, with 20% precision at admission and 19% precision at discharge. CONCLUSION Rasch-based scoring was more precise in differentiating patient groups by discharge destination than the summative scoring used to measure upper limb function, especially at the extreme range of the scale.

Measures of participation outcomes related to hand use for 2- to 12-year-old children with disabilities: a systematic review

Many interventions have been used to improve childrens hand-related impairments or hand skill performance in functional activities so as to promote life participation. There is thus a need to have suitable instruments assessing childrens participation in life situations that specifically require hand use in order to support and evaluate such interventions. This systematic review investigated the availability of potential instruments that can be used to assess childrens participation specifically in life situations requiring hand use. Clinical utility and evidence for psychometric properties were also sourced. Database searches initially identified measures that were used to evaluate participation of children aged 2-12 years, involved self- or proxy report or interview administration and had generic application for a range of disabilities/diagnoses. These measures were further evaluated to determine if they fulfilled the above inclusion criteria and contained at least 60% of the items involving hand use. Further searches for psychometric evidence were undertaken for the eligible measures. Fourteen measures were identified and nine met the inclusion criteria. However, none of these measures, except for the Children Helping Out: Responsibilities, Expectations, and Supports (CHORES), contained all items related to hand use. Most of the included measures had limited psychometric properties. Only the Childrens Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC), the School Function Assessment-Participation section (SFA-P) and the Children Participation Questionnaire (CPQ) revealed sufficient evidence of validity and reliability. The findings suggest a need for adapting existing participation measures or developing new ones that specifically assess participation in life situations requiring hand use to support interventions.

Motor skill assessment of children: Is there an association between performance-based, child-report, and parent-report measures of children's motor skills?

ABSTRACT Client-centered practice requires therapists to actively seek the perspectives of children and families. Several assessment tools are available to facilitate this process. However, when evaluating motor skill performance, therapists typically concentrate on performance-based assessment. To improve understanding of the information provided by the different approaches, the study investigated correlations between performance-based, child-report, and parent-report measures of childrens motor skill performance. A sample of convenience of 38 children 8–12 years of age with no history of motor or intellectual impairments and their parents was recruited from Victoria, Australia. Scores for the Bruininks–Oseretsky Test of Motor Proficiency (performance-based, administered by a therapist), Physical Self-Description Questionnaire (child report), and Movement Assessment Battery for Children Checklist (parent report) were analyzed using Spearmans rho correlation. Several significant moderate-to-large correlations were found between scores for parent-report and scores for performance-based assessments, while few significant correlations were found between scores for child report and scores for the other two measures. The results suggest that children offer a unique perspective which should be integrated with other sources of information to gain a more holistic perspective of their motor skill performance.

Establishing the Validity and Reliability of the Student Practice Evaluation Form–Revised (SPEF-R) in Occupational Therapy Practice Education: A Rasch Analysis

This study investigated construct validity and internal consistency of the Student Practice Evaluation Form–Revised Edition Package (SPEF-R) which evaluates students’ performance on practice education placements. The SPEF-R has 38 items covering eight domains, and each item is rated on a 5-point rating scale. Data from 125 students’ final placement evaluations in their final year study were analyzed using the Rasch measurement model. The SPEF-R exhibited satisfactory rating scale performance and unidimensionality across the eight domains, providing construct validity evidence. Only 2 items misfit Rasch model’s expectations (both related to students’ performance with client groups, which were often rated as not observed). Additionally, the internal consistency of each SPEF-R domain was found to be excellent (Cronbach’s α = .86 to .91) and all individual items had reasonable to excellent item-total correlation coefficients. The study results indicate that the SPEF-R can be used with confidence to evaluate students’ performance during placements, but continued validation and refinement are required.

Rasch analysis of the assessment of children’s hand skills in children with and without disabilities

The Assessment of Childrens Hand Skills (ACHS) is a new assessment tool that utilizes a naturalistic observational method to capture childrens real-life hand skill performance when engaging in various types of activities. The ACHS also intends to be used with both typically developing children and those presenting with disabilities. The purpose of this study was to further investigate the construct validity of the ACHS using the Rasch analysis. Participants included 64 typically developing children and 70 children with disabilities in the age range of 2-12 years. Rasch analysis results confirmed the appropriateness of the ACHSs 6-level rating scale in this combined group of children. All 22 activity items and 19 of the 20 hand skill items in the ACHS formed a unidimensional scale and were ordered according to difficulty as clinically and developmentally expected. The ACHS also exhibited sufficient response validity and item-difficulty range when applied to children with disabilities as well as typically developing, preschool-age children. Furthermore, less than half of the ACHS items were found to exhibit differential item functioning with regard to gender (5 activity items) and disability (2 activity items and 7 hand skill items). Therefore, the ACHS shows preliminary evidence of construct validity for its clinical use in assessing childrens hand skill performance in real-life contexts.

Development and validation of a WHOQOL-BREF Taiwanese audio player-assisted interview version for the elderly who use a spoken dialect

A quality of life questionnaire is rarely adapted to an interview mode for people who mainly use spoken language in daily life. In Taiwan, the WHOQOL-BREF (Mandarin Chinese version) has been developed, as a self-administered questionnaire, but it cannot be applied to the majority of the elderly in Taiwan, who speak only Taiwanese (a dialect). This study adopted the audio player-assisted interview mode to develop a Taiwanese version of the WHOQOL-BREF specifically for Taiwanese-speaking elderly people, and followed with examinations of the reliability and validity of this version. Initially, the WHOQOL-BREF (English version) was translated into colloquial Taiwanese, and field tests confirmed the equivalence and appropriateness of the translation. A total of 228 Taiwanese-speaking elderly people were assessed using the Taiwanese interview version, of which 144 subjects were re-assessed two weeks later. Interviewers assessed each subject aided by an audio player on which all the translated WHOQOL-BREF contents were recorded. The Taiwanese interview version of the WHOQOL-BREF, except for the item related to dependence on medication, showed acceptable reliability (internal consistency, corrected item-domain correlation, and test–retest reliability) and validity (criterion-related, convergent, and discriminant validity). Confirmatory factor analyses supported the four-factor model of the Taiwanese interview version, providing evidence for construct validity. The results suggest that the Taiwanese audio player-assisted interview version of the WHOQOL-BREF was reliable and valid in assessing quality of life of elderly Taiwanese.

Development and psychometric evaluation of a new measure for children's participation in hand-use life situations

OBJECTIVE To describe the development of the Childrens Assessment of Participation with Hands, a parent-report questionnaire that assesses childrens participation in life situations requiring hand use specifically, and to investigate its construct validity (using Rasch analysis and known-group comparison) and reliability (test-retest reliability and internal consistency). DESIGN Cross-sectional, validation, and test-retest studies. SETTING Schools. PARTICIPANTS Parents/caregivers (N=202) reported on their children aged 2 to 12 years with (n=97) and without disabilities (n=105). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The Childrens Assessment of Participation with Hands was developed based on a content review of existing childrens participation measures and literature, expert review, and pilot testing. The Childrens Assessment of Participation with Hands included 37 items measuring participation diversity, frequency, independence, and desire for change in specific hand-use life situations across 4 domains of self-care, recreation, education, and domestic life and community. RESULTS Evidence for construct validity of the Childrens Assessment of Participation with Hands domains was established through Rasch analysis (after removing 2 misfitting items from the recreational domain and 1 item from the domestic life and community domain). Differences in summary scores of each domain between children with and without disabilities were also significant (P<.01). Test-retest reliability of the Childrens Assessment of Participation with Hands was moderate to high (intraclass correlation coefficients, .69-.96), except for the desire for change dimension scale of the recreational domain (.40). Internal consistency was varied across the dimensions/domains. CONCLUSIONS Results provide preliminary evidence for the construct validity and reliability of the Childrens Assessment of Participation with Hands that could be used in clinical and research settings to gain a specific understanding of the impact of childrens hand-use difficulties on their participation in life situations requiring hand use.