对720例脑瘫患儿的儿科结局数据收集工具进行拉施分析。

Rasch analysis of the pediatric outcomes data collection instrument in 720 patients with cerebral palsy.

作者信息

Park Moon Seok, Chung Chin Youb, Lee Kyoung Min, Sung Ki Hyuk, Choi In Ho, Cho Tae-Joon, Yoo Won Joon, Lee Sang Hyeong, Kwon Dae Gyu, Kim Tae Won

机构信息

Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Korea.

出版信息

J Pediatr Orthop. 2012 Jun;32(4):423-31. doi: 10.1097/BPO.0b013e31824b2a1f.

DOI:10.1097/BPO.0b013e31824b2a1f

PMID:22584846

Abstract

BACKGROUND

The pediatric outcomes data collection instrument (PODCI) was originally developed to carry out a functional assessment of children and adolescents (including patients with cerebral palsy), focusing on musculoskeletal health. Validated questionnaires are important for assessing the functional outcome of cerebral palsy, and are meant to have unidimensionality, proper item gap, no ceiling and floor effects, and no item redundancy. The advances in health measurements have led to the application of Rasch analysis to assess questionnaires. This study evaluated PODCI in patients with cerebral palsy using Rasch analyses.

METHODS

The study included a total of 720 patients with gross motor function classification system level I to III, 192 with unilateral involvement and 528 with bilateral involvement. Rasch analysis was performed to obtain information on (1) the information weight fit statistic to assess the unidimensionality and redundancy of the items in each domain; (2) average item calibration to detect the item separation; and (3) item map to evaluate the ceiling and floor effects.

RESULTS

The PODCI worked best in the sports/physical function domain. In information weight fit statistics, there were 4 items violating unidimensionality, which included "putting on his/her coat" in transfer/basic mobility and "getting together and do things with friends" in sports/physical function. There were 4 items with item redundancy. Inadequate item separation was observed in the transfer/basic mobility domain. A ceiling effect was found in all domains, except for the sports/physical function.

CONCLUSIONS

The sports/physical function domain in PODCI generally satisfies the requirements of Rasch item response theory and is an appropriate measure of the function in cerebral palsy. Although some individual items do not fit well, the PODCI can be improved by eliminating the redundant items and by adding more difficult tasks to fill in the gaps.

LEVEL OF EVIDENCE

Level II.

摘要

背景

儿科结局数据收集工具（PODCI）最初是为对儿童和青少年（包括脑瘫患者）进行功能评估而开发的，重点关注肌肉骨骼健康。经过验证的问卷对于评估脑瘫的功能结局很重要，并且应具有单维度性、适当的项目间距、无天花板效应和地板效应以及无项目冗余。健康测量的进展导致应用拉施分析来评估问卷。本研究使用拉施分析评估了脑瘫患者的PODCI。

方法

该研究共纳入720例粗大运动功能分类系统I至III级的患者，其中192例为单侧受累，528例为双侧受累。进行拉施分析以获取有关以下方面的信息：（1）信息权重拟合统计量，以评估每个领域中项目的单维度性和冗余性；（2）平均项目校准，以检测项目区分度；（3）项目图，以评估天花板效应和地板效应。

结果

PODCI在运动/身体功能领域表现最佳。在信息权重拟合统计中，有4个项目违反了单维度性，其中包括转移/基本移动性方面的“穿上他/她的外套”以及运动/身体功能方面的“与朋友聚在一起做事”。有4个项目存在项目冗余。在转移/基本移动性领域观察到项目区分度不足。除运动/身体功能外，所有领域均发现有天花板效应。