Ickpyo Hong

Equating activities of daily living outcome measures: the Functional Independence Measure and the Korean version of Modified Barthel Index

Abstract Purpose: To create a crosswalk between the Functional Independence Measure (FIM) motor items and the Korean version of the Modified Barthel Index (K-MBI). Method: Korean community-dwelling adult patients (n = 276) completed the FIM and K-MBI on the same day in outpatient rehabilitation hospitals. We used a single group design with the Rasch common person equating and conducted a factor analysis of the co-calibrated item pool using the two measures. Rasch analysis was used to investigate the psychometrics of the equated test items in the identified factor structure(s). The correlation between FIM raw scores and converted K-MBI scores was examined. Results: Three measurement constructs were identified: self-care, mobility, involuntary movement. The equated test items in the three constructs demonstrated good person separation reliability (r = 0.94–0.96) and good internal consistency (Cronbach’s alpha =0.93–0.97). The three crosswalks between the FIM raw scores and converted K-MBI scores demonstrated good correlations (r = 0.91–0.93, all p < 0.0001). Conclusions: The Rasch equating method successfully created three crosswalks between the FIM motor items and K-MBI, with the equated test items demonstrating good psychometrics. The crosswalks would address the incomparable scoring systems between the FIM motor items and K-MBI. Implications for Rehabilitation The three crosswalk tables (scoring tables) would allow clinicians to compare or translate a patient’s motor scores between the FIM and K-MBI. The crosswalk tables would allow health-care administrators to track patients’ functional status across various rehabilitation facilities that exclusively use the FIM or K-MBI.

Relationship Between Physical Activity and Overweight and Obesity in Children: Findings From the 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey

OBJECTIVE This study examined the relationship between childhood obesity and overweight and functional activity and its enjoyment. METHOD A cross-sectional design was used to analyze data from the 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey. Multivariate logistic regression models were used. RESULTS Data for 1,640 children ages 3-15 yr were retrieved. Physical activity was negatively associated with risk of obesity (odds ratio [OR] = 0.93; 95% confidence interval [CI] [0.87, 0.98]). Although children who were obese and overweight were more likely to have functional limitations (ORs = 1.58-1.61), their enjoyment of physical activity participation was not significantly different from that of the healthy-weight group. CONCLUSION Physical activity lowered the risk of obesity. Children who were obese had functional limitations compared with healthy-weight children, but both groups enjoyed physical activity equally. Future studies are needed to determine barriers to participation among these children in recreation and sporting activities.

Linking Existing Instruments to Develop an Activity of Daily Living Item Bank

This study examined dimensionality and item-level psychometric properties of an item bank measuring activities of daily living (ADL) across inpatient rehabilitation facilities and community living centers. Common person equating method was used in the retrospective veterans data set. This study examined dimensionality, model fit, local independence, and monotonicity using factor analyses and fit statistics, principal component analysis (PCA), and differential item functioning (DIF) using Rasch analysis. Following the elimination of invalid data, 371 veterans who completed both the Functional Independence Measure (FIM) and minimum data set (MDS) within 6 days were retained. The FIM-MDS item bank demonstrated good internal consistency (Cronbach’s α = .98) and met three rating scale diagnostic criteria and three of the four model fit statistics (comparative fit index/Tucker–Lewis index = 0.98, root mean square error of approximation = 0.14, and standardized root mean residual = 0.07). PCA of Rasch residuals showed the item bank explained 94.2% variance. The item bank covered the range of θ from −1.50 to 1.26 (item), −3.57 to 4.21 (person) with person strata of 6.3. The findings indicated the ADL physical function item bank constructed from FIM and MDS measured a single latent trait with overall acceptable item-level psychometric properties, suggesting that it is an appropriate source for developing efficient test forms such as short forms and computerized adaptive tests.

Development and Validation of the Activities of Daily Living Short Form for Community-Dwelling Korean Stroke Survivors

This study developed and validated a short form (SF) using activities of daily living (ADL) outcome measures from the Korea National Health and Nutrition Examination Survey (KNHANES) that can minimize survey administration burden for clinicians. This study utilized secondary data from the 2005 KNHANES with 422 community-dwelling stroke survivors. The KNHANES data were collected from April to June 2005 in South Korea. We created a 7-item SF from the 17 ADL questions in the survey using item response theory (IRT) methodologies. The precision and validity of the SF were compared to the full questionnaire of ADL items and the EuroQol-5D total score. Among the 17 ADL questions, 14 questions demonstrated unidimensional construct validity. Using IRT methodologies, a set of 7 items were selected from the full bank. The 7-item SF demonstrated good psychometric properties: high correlation with the full bank (r = .975, p < .001), good internal consistency (Cronbach’s α = .93), and a high correlation with the EuroQol-5D total score (r = .678, p < .001). These findings indicate that a well-developed SF can precisely measure ADL performance capacity for stroke survivors compared to the full item bank, which is expected to reduce the administration burden of the KNHANES.

Psychometric properties of upper extremity outcome measures validated by Rasch analysis: a systematic review

The aim of this study was to provide a systematic review of psychometric studies of upper extremity (UE) outcome measures validated by Rasch analysis and assess the extent to which their measurement areas cover the domains of the International Classification of Functioning, Disability and Health model. A literature search from 1966 to 2014 was performed using PubMed, CINAHL, Scopus, PsycINFO, Ovid/MEDLINE, ERIC, and Cochrane library. Fourteen keywords indicating ‘upper extremity’, ‘psychometric properties’, and ‘outcome measures’ were used. From a total of 1039 studies, 17 UE impairment outcome measures that fulfilled the inclusion criteria were selected and reviewed. The instruments targeted adults with various neurological or orthopedic conditions (i.e. stroke, upper and lower extremity impairments, and back pain). Twelve instruments targeted the body structure/function domain and 11 instruments targeted the activity domain of the International Classification of Functioning, Disability and Health model. Only two instruments targeted the participation domain. All outcome measures showed reasonably sound psychometric properties, including construct validity (good fit statistic), moderate to high reliability (r=0.86–0.99), and sound dimensionality (unidimensional). The reviewed psychometric properties of UE outcome measures are useful for clinicians in deciding which measures to use to assess patients’ UE impairments.

Construct validity of the Eating Assessment Tool (EAT-10)

Abstract Purpose: We aimed to evaluate the construct validity of the Eating Assessment Tool (EAT-10) by determining its dimensionality, rating scale integrity, item-person match, precision and relationship with the degree of airway invasion and functional oral intake. Methods: We conducted a retrospective analysis of patients’ EAT-10 scores. We used the Rasch rating scale model. We investigated correlations between the EAT-10 and scores on the Penetration-Aspiration Scale (PAS) and Functional Oral Intake Scale (FOIS). Results: The median score of the EAT-10 from 127 patients was 16 of 40 (range 0–40). Confirmatory factor analysis supported unidimensionality. The 5-point rating scale categories met published criteria. Two items misfit the Rasch model and two other items displayed differential item functioning. Rasch person reliability was 0.79. Our patient cohort was divided into three person-strata. Correlations between the EAT-10 and the PAS and FOIS were weak to moderate in strength (respectively: r = 0.26, p = 0.0036; r = −0.27, p = 0.0027). Conclusions: Our analyses identified deficits in the construct validity of the EAT-10 suggestive of a need to improve the EAT-10 to support its frequent use in clinical practice and research. Implications for Rehabilitation Swallowing disorders are associated with severe complications, such as pneumonia and malnutrition, and impose both social and psychological burdens on patients. The Eating Assessment Tool is a self-report instrument developed to estimate initial dysphagia severity and monitor change in patient-reported dysphagia symptoms as a response to treatment. This study shows that the Eating Assessment Tool has deficits in its construct validity and a need to improve the instrument to support its frequent use in clinical practice and research.

Physical Activity and the Risk of Depression in Community-Dwelling Korean Adults With a History of Stroke.

Background Physical activity (PA) is believed to improve mental health, including depression. However, whether recommended PA levels have a similar impact in individuals with poststroke depression is unclear. Objective The aim of this study was to apply a quasi‐experimental propensity score (PS) matching control for covariate differences and compare the effects of PA on reducing depression risk among people with stroke. Design A cross‐sectional design was used for this study. Methods Health‐related information for community‐dwelling adults (N=4,555) who reported having had a stroke was extracted from the 2013 Korean Community Health Survey data set. The survey participants were asked a series of questions about depression, recommended PA levels (moderate and vigorous intensity), and chronic conditions. A multivariable regression model, inverse probability weighting adjustment, and Greedy algorithms with 1:1 matching and covariate adjustment were used to estimate the effects of PA on risk of depression. The dependent variable was diagnosis of depression, and the primary independent variable was PA. Baseline covariates were 10 demographic and 9 chronic condition variables. Results Without PS methods, there were significant differences in baseline covariates (16 out of 19) between people who performed PA and those who did not perform PA. After applying 1:1 matching, the number of patients in each group comparing the effect of PA numbered 1,970, and 13 covariates did not differ significantly between the 2 groups. Physical activity reduced the risk of poststroke depression by 36.1% to 42.4% (odds ratio=0.639‐0.376) across the 3 methods. Limitations Unaccounted‐for covariates, including stroke severity, predepression status, and history of depression treatments, may have biased the results. Conclusions The findings suggest that recommended PA levels have protective relationships with the risk of poststroke depression.

Longitudinal Trends in Fall Accidents in Community Dwelling Korean Adults: The 2008–2013 Korean Community Health Survey

Objective To describe the longitudinal characteristics of unintentional fall accidents using a representative population-based sample of Korean adults. Methods We examined data from the Korean Community Health Survey from 2008 to 2013. Univariate analysis and multivariable logistic regression were used to identify the characteristics of fall accidents in adults. Results Between 2008 and 2013, the incidence rate of fall accidents requiring medical treatment increased from 1,248 to 3,423 per 100,000 people (p<0.001), while the proportion of indoor fall accidents decreased from 38.12% to 23.16% (p<0.001). Females had more annual fall accidents than males (p<0.001). The major reason for fall accidents was slippery floors (33.7% in 2011 and 36.3% in 2013). Between 2008 and 2010, variables associated with higher fall accident risk included specific months (August and September), old age, female gender, current drinker, current smoker, diabetes, osteoarthritis, osteoporosis, and depression. A high level of education and living with a partner were negatively associated with fall accident risk. In 2013, people experiencing more than 1 fall accident felt more fear of falling than those having no fall accidents (odds ratio [OR] for 1 fall, 2.12; 95% confidence interval [CI], 2.04–2.12; OR for more than 2 falls, 2.97; 95% CI, 2.83–3.10). Conclusion The occurrence of fall accidents has consistently increased in Korea from 2008 to 2013. Future intervention studies are needed to reduce the increasing incidence rates of fall accidents in community dwelling adults.

Generating Rasch-based activity of daily living measures from the Spinal Cord Injury Longitudinal Aging Study

Study design:Retrospective Longitudinal Study.Objectives:(1) To determine whether the Spinal Cord Injury Activities of Daily Living (SCI_ADL) measure shows adequate item-level and precision psychometrics; (2) to investigate whether the SCI_ADL measure effectively detects ADL changes across time; (3) to describe self-care task(s) participants can and cannot do across time.Setting:Two Midwestern hospitals and 1 Southeastern specialty hospital in 1993.Methods:All participants were adults with traumatic SCI of at least 1-year duration at enrollment. We used 20-year (1993–2013) retrospective longitudinal data and categorized participants into three injury levels: C1–C4 (cervical; n=50), C5–C8 (n=126) and T1–S5 (thoracic, lumbar and sacral; n=168). We first examined psychometrics of the SCI_ADL with factor and Rasch analyses; then we investigated longitudinal change of SCI_ADL scores at three time points over 20 years (1993, 2003 and 2013) using generalized linear mixed modeling and post hoc analyses.Results:The SCI_ADL measure demonstrated unidimensionality, person strata of 2.9, high Cronbach’s α (0.93) and fair person reliability (0.76). T1–S5 had the highest measures, following C5–C8 and C1–C4 at three time points (P<0.05). The C1–C4 and T1–S5 groups showed significant decreases from 2003 to 2013; however, none of the three groups showed significant differences from 1993 to 2003 (P<0.05).Conclusions:The SCI_ADL measure could detect longitudinal ADL changes of the population with SCI across time. The C1–C4 group decreased the most in ADLs, indicating higher need of long-term services and rehabilitation.

Feasibility Study Using Propensity Score Matching Methods for the Pseudo-Common Person Equating Requirement

We tested if a propensity score (PS) matching method supports the unidimensionality assumption of the Rasch model which is critical to link similar rehabilitation instruments. We obtained 1,013 respondents from the 2009 Hispanic Established Populations for Epidemiologic Studies of the Elderly Frailty study. We used a unidimensional item pool of 10 SF-36 physical function and nine activities of daily living items. Subjects were matched based on their functionality (high and low), and exploratory factor analysis was used to test if the item pool in the matched sample holds the unidimensionality assumption. The study findings revealed that the matched sample demonstrated two distinct measurement structures with excellent model fit. This finding indicates that the PS matching did not mimic the common-person assumption. Therefore, the combination of PS matching and common-person equating method may not be appropriate to equate two rehabilitation-related instruments administered to two different groups.