Silvia Testa

Quality of life and patient preferences: identification of subgroups of multiple sclerosis patients

PurposeThe aim of this study was to estimate preferences related to quality of life attributes in people with multiple sclerosis, by keeping heterogeneity of patient preference in mind, using the latent class approach.MethodsA discrete choice experiment survey was developed using the following attributes: activities of daily living, instrumental activities of daily living, pain/fatigue, anxiety/depression and attention/concentration. Choice sets were presented as pairs of hypothetical health status, based upon a fractional factorial design.ResultsThe latent class logit model estimated on 152 patients identified three subpopulations, which, respectively, attached more importance to: (1) the physical dimension; (2) pain/fatigue and anxiety/depression; and (3) instrumental activities of daily living impairments, anxiety/depression and attention/concentration. A posterior analysis suggests that the latent class membership may be related to an individual’s age to some extent, or to diagnosis and treatment, while apart from energy dimension, no significant difference exists between latent groups, with regard to Multiple Sclerosis Quality of Life-54 scales.ConclusionsA quality of life preference-based utility measure for people with multiple sclerosis was developed. These utility values allow identification of a hierarchic priority among different aspects of quality of life and may allow physicians to develop a care programme tailored to patient needs.

Development of a Short Version of MSQOL-54 Using Factor Analysis and Item Response Theory.

Background The Multiple Sclerosis Quality of Life-54 (MSQOL-54, 52 items grouped in 12 subscales plus two single items) is the most used MS specific health related quality of life inventory. Objective To develop a shortened version of the MSQOL-54. Methods MSQOL-54 dimensionality and metric properties were investigated by confirmatory factor analysis (CFA) and Rasch modelling (Partial Credit Model, PCM) on MSQOL-54s completed by 473 MS patients. Their mean age was 41 years, 65% were women, and median Expanded Disability Status Scale (EDSS) score was 2.0 (range 0–9.5). Differential item functioning (DIF) was evaluated for gender, age and EDSS. Dimensionality of the resulting short version was assessed by exploratory factor analysis (EFA) and CFA. Cognitive debriefing of the short instrument (vs. the original) was then performed on 12 MS patients. Results CFA of MSQOL-54 subscales showed that the data fitted the overall model well. Two subscales (Role Limitations—Physical, Role Limitations—Emotional) did not fit the PCM, and were removed; two other subscales (Health Perceptions, Social Function) did not fit the model, but were retained as single items. Sexual Satisfaction (single-item subscale) was also removed. The resulting MSQOL-29 consisted of 25 items grouped in 7 subscales, plus 4 single items. PCM fit statistics were within the acceptability range for all MSQOL-29 items except one which had significant DIF by age. EFA and CFA indicated adequate fit to the original two-factor (Physical and Mental Health Composites) hypothesis. Cognitive debriefing confirmed that MSQOL-29 was acceptable and had lost no key items. Conclusions The proposed MSQOL-29 is 50% shorter than MSQOL-54, yet preserves key quality of life dimensions. Prospective validation on a large, independent MS patient sample is ongoing.

Psychometric Properties of the Theory of Mind Assessment Scale in a Sample of Adolescents and Adults

This research aimed at the evaluation of the psychometric properties of the Theory of Mind Assessment Scale (Th.o.m.a.s.). Th.o.m.a.s. is a semi-structured interview meant to evaluate a persons Theory of Mind (ToM). It is composed of several questions organized in four scales, each focusing on one of the areas of knowledge in which such faculty may manifest itself: Scale A (I-Me) investigates first-order first-person ToM; Scale B (Other-Self) investigates third-person ToM from an allocentric perspective; Scale C (I-Other) again investigates third-person ToM, but from an egocentric perspective; and Scale D (Other-Me) investigates second-order ToM. The psychometric proprieties of Th.o.m.a.s. were evaluated in a sample of 156 healthy persons: 80 preadolescent and adolescent (aged 11–17 years, 42 females) and 76 adults (aged from 20 to 67 years, 35 females). Th.o.m.a.s. scores show good inter-rater agreement and internal consistency; the scores increase with age. Evidence of criterion validity was found as Scale B scores were correlated with those of an independent instrument for the evaluation of ToM, the Strange Stories task. Confirmatory factor analysis (CFA) showed good fit of the four-factors theoretical model to the data, although the four factors were highly correlated. For each of the four scales, Rasch analyses showed that, with few exceptions, items fitted the Partial credit model and their functioning was invariant for gender and age. The results of this study, along with those of previous researches with clinical samples, show that Th.o.m.a.s. is a promising instrument to assess ToM in different populations.

Factorial structure of the 'ToM Storybooks': A test evaluating multiple components of Theory of Mind.

This study examined the factorial structure of the Theory of Mind (ToM) Storybooks, a comprehensive 93-item instrument tapping the five components in Wellmans model of ToM (emotion recognition, understanding of desire and beliefs, ability to distinguish between physical and mental entities, and awareness of the link between perception and knowledge). A sample of 681 three- to eight-year-old Italian children was divided into three age groups to assess whether factorial structure varied across different age ranges. Partial credit model analysis was applied to the data, leading to the empirical identification of 23 composite variables aggregating the ToM Storybooks items. Confirmatory factor analysis was then conducted on the composite variables, providing support for the theoretical model. There were partial differences in the specific composite variables making up the dimensions for each of the three age groups. A single test evaluating distinct dimensions of ToM is a valuable resource for clinical practice which may be used to define differential profiles for specific populations.

Muslim Acculturation in a Catholic Country: Its Associations With Religious Identity, Beliefs, and Practices

The literature suggests that religion may play an important role in the acculturation process of immigrants by contributing to the maintenance of the heritage culture and preventing identification with the mainstream. With few exceptions, studies on this topic have focused on religion as a whole by assessing specific aspects or dimensions (such as religious identification, beliefs, and practices) and creating a composite measure without analyzing the contribution of each dimension to the acculturation process. In this study, the relationships between specific religious dimensions and acculturation were assessed with a sample of 282 Muslim immigrants who were recruited in the northern part of Italy. Two regression models show that religious identification drives the maintenance of Muslim culture but is unrelated to the acculturation to Italian culture, whereas beliefs and practices do not contribute to heritage acculturation but are negatively associated to acculturation to the host culture.

The dimensions of emotional meaning in modern Greek

The aim of this study was to investigate the meaning structure of emotion terms from the Greek lexicon, and to assess commonalities and differences with the maps of emotional words obtained in a prior study of neo-Latin languages, a linguistic family sharing ancient roots with the Greek tongue. Twelve native speakers contributed to the selection of 33 Greek terms with a clear emotional meaning and an independent sample of 30 participants evaluated the pairwise similarities among the target words. The similarity ratings were subjected to multidimensional scaling analyses, yielding a three-dimensional configuration (Valence, Physiological Activation and Potency) in which the coping potential dimension (Potency) was more important than, or at least as important as, the Physiological Activation dimension. The map resembled that previously identified for the core neo-Latin languages, namely Italian, French and Spanish, and was quite different from those obtained for other more peripheral neo-Latin languages, and also from those obtained in some studies involving English emotion lexicon. Reasons for these similarities and differences are discussed.

eMSQOL-29: Prospective validation of the abbreviated, electronic version of MSQOL-54

Background: We recently devised a shortened version of the 54-item Multiple Sclerosis Quality of Life (MSQOL-54) in paper (MSQOL-29, consisting of 25 items forming 7 subscales and 4 single items, and one filter question for 3 ‘sexual function’ items) and electronic format (eMSQOL-29). Objectives: To prospectively assess eMSQOL-29 psychometric properties, acceptability/equivalence versus MSQOL-29. Methods: Multiple sclerosis (MS) patients (n = 623; Expanded Disability Status Scale (EDSS) range 0.0–9.0) completed eMSQOL-29, Hospital Anxiety and Depression Scale, Functional Assessment of MS (FAMS), European Quality of life Five Dimensions-3L, and received EDSS and Symbol Digit Modalities Test (SDMT). Equivalence versus MSQOL-29 was assessed in 242 patients (randomized cross-over design). Results: ‘Sexual function’ items were filtered out by 273 patients (47%). No multi-item scale had floor effect, while five had ceiling effect. Cronbach’s alpha range was 0.88–0.90. Confirmatory factor analysis showed good overall fit and the two-factor solution for composite scores was confirmed. Criterion validity was sub-optimal for ‘cognitive function’ (vs SDMT, r = 0.25) and ‘social function’ (vs FAMS social function, r = 0.38). eMSQOL-29 equivalence was confirmed and its acceptability was good. Conclusion: eMSQOL-29 showed good internal consistency, factor structure and no floor effect, while most subscales had some ceiling effect. Criterion validity was sub-optimal for two subscales. Equivalence and acceptability were good.

Distractor Efficiency in an Item Pool for a Statistics Classroom Exam: Assessing Its Relation With Item Cognitive Level Classified According to Bloom’s Taxonomy

Multiple-choice items are one of the most commonly used tools for evaluating students’ knowledge and skills. A key aspect of this type of assessment is the presence of functioning distractors, i.e., incorrect alternatives intended to be plausible for students with lower achievement. To our knowledge, no work has investigated the relationship between distractor performance and the complexity of the cognitive task required to give the correct answer. The aim of this study was to investigate this relation, employing the first three levels of Bloom’s taxonomy (Knowledge, Comprehension, and Application). Specifically, it was hypothesized that items classified into a higher level of Bloom’s classification would show a greater number of functioning distractors. The study involved 174 items administered to a sample of 848 undergraduate psychology students during their statistics exam. Each student received 30 items randomly selected from the 174-item pool. The bivariate results mainly supported the authors’ hypothesis: the highest percentage of functioning distractors was observed among the items classified into the Application category (η2 = 0.024 and Phi = 0.25 for the dichotomized measure). When the analysis controlled for other item features, it lost statistical significance, partly because of the confounding effect of item difficulty.

The Factor Structure of the CA-MIR as Evaluated Using Confirmatory Factor Analysis

Introduction: The aim of the current study was to evaluate the factor structure of the CArtes- Modèles Individuels de Relations (CA-MIR), a self-report questionnaire designed to tap into the relational strategies of adults that was developed by a French-speaking research group coordinated by Blaise Pierrehumbert. The CA-MIRs particular merit lies in the richness and complexity of the theoretical model underpinning it. However, to date, this model has only been partially reproduced in studies using exploratory analysis and has never been tested via confirmatory factor analysis (CFA). Objective and Method: We thus conducted CFA on data collected from a sample of 979 subjects, recruited using a snowball sampling method during the spring and fall of 2005. To assess if some item multidimensionality was present, we estimated both the independent clusters model (ICM-CFA) and a model in which some zero loading restrictions were removed. Results: The results supported the originally proposed structure of the CA-MIR; the large majority of items were good indicators of the expected latent dimensions and only few items showed relevant secondary loadings or loaded in an unexpected factor. The instrument adequately differentiates the three attachment styles, taking into account both past and present experiences of attachment relationships, and providing a rich and complex assessment of multiple features of attachment. In terms of internal consistency, alpha values were satisfactory and comparable to those found in the original Swiss validation study. Conclusions: Our results are of key importance for both research and clinical work, given the lack of valid and easy-to-administer tools for evaluating adult attachment.