Teresi Jeanne A, Ocepek-Welikson Katja, Cook Karon F, Kleinman Marjorie, Ramirez Mildred, Reid M Carrington, Siu Albert
New York State Psychiatric Institute.
Research Division, Hebrew Home at Riverdale; RiverSpring Health.
Psychol Test Assess Model. 2016;58(2):309-352.
Reducing the response burden of standardized pain measures is desirable, particularly for individuals who are frail or live with chronic illness, e.g., those suffering from cancer and those in palliative care. The Patient Reported Outcome Measurement Information System (PROMIS) project addressed this issue with the provision of computerized adaptive tests (CAT) and short form measures that can be used clinically and in research. Although there has been substantial evaluation of PROMIS item banks, little is known about the performance of PROMIS short forms, particularly in ethnically diverse groups. Reviewed in this article are findings related to the differential item functioning (DIF) and reliability of the PROMIS pain interference short forms across diverse sociodemographic groups.
DIF hypotheses were generated for the PROMIS short form pain interference items. Initial analyses tested item response theory (IRT) model assumptions of unidimensionality and local independence. Dimensionality was evaluated using factor analytic methods; local dependence (LD) was tested using IRT-based LD indices. Wald tests were used to examine group differences in IRT parameters, and to test DIF hypotheses. A second DIF-detection method used in sensitivity analyses was based on ordinal logistic regression with a latent IRT-derived conditioning variable. Magnitude and impact of DIF were investigated, and reliability and item and scale information statistics were estimated.
The reliability of the short form item set was excellent. However, there were a few items with high local dependency, which affected the estimation of the final discrimination parameters. As a result, the item, "How much did pain interfere with enjoyment of social activities?" was excluded in the DIF analyses for all subgroup comparisons. No items were hypothesized to show DIF for race and ethnicity; however, five items showed DIF after adjustment for multiple comparisons in both primary and sensitivity analyses: ability to concentrate, enjoyment of recreational activities, tasks away from home, participation in social activities, and socializing with others. The magnitude of DIF was small and the impact negligible. Three items were consistently identified with DIF for education: enjoyment of life, ability to concentrate, and enjoyment of recreational activities. No item showed DIF above the magnitude threshold and the impact of DIF on the overall measure was minimal. No item showed gender DIF after correction for multiple comparisons in the primary analyses. Four items showed consistent age DIF: enjoyment of life, ability to concentrate, day to day activities, and enjoyment of recreational activities, none with primary magnitude values above threshold. Conditional on the pain state, Spanish speakers were hypothesized to report less pain interference on one item, enjoyment of life. The DIF findings confirmed the hypothesis; however, the magnitude was small. Using an arbitrary cutoff point of theta () ≥ 1.0 to classify respondents with acute pain interference, the highest number of changes were for the education groups analyses. There were 231 respondents (4% of the total sample) who changed from the designation of no acute pain interference to acute interference after the DIF adjustment. There was no change in the designations for race/ethnic subgroups, and a small number of changes for respondents aged 65 to 84.
Although significant DIF was observed after correction for multiple comparisons, all DIF was of low magnitude and impact. However, some individual-level impact was observed for low education groups. Reliability estimates were high. Thus, the PROMIS short form pain items examined in this ethnically diverse sample performed relatively well; although one item was problematic and removed from the analyses. It is concluded that the majority of the PROMIS pain interference short form items can be recommended for use among ethnically diverse groups, including those in palliative care and with cancer and chronic illness.
降低标准化疼痛测量的应答负担是可取的，特别是对于体弱或患有慢性病的个体，例如癌症患者和姑息治疗患者。患者报告结局测量信息系统（PROMIS）项目通过提供计算机自适应测试（CAT）和可在临床及研究中使用的简表测量方法解决了这一问题。尽管对PROMIS题库进行了大量评估，但对于PROMIS简表的性能了解甚少，尤其是在种族多样化群体中。本文回顾了PROMIS疼痛干扰简表在不同社会人口学群体中的项目功能差异（DIF）和信度相关的研究结果。
针对PROMIS简表疼痛干扰项目生成DIF假设。初始分析测试了项目反应理论（IRT）模型的单维性和局部独立性假设。使用因子分析方法评估维度；使用基于IRT的局部依赖性（LD）指标测试局部依赖性。使用Wald检验检查IRT参数的组间差异，并检验DIF假设。敏感性分析中使用的第二种DIF检测方法基于带有潜在IRT衍生条件变量的有序逻辑回归。研究了DIF的大小和影响，并估计了信度以及项目和量表信息统计量。
简表项目集的信度极佳。然而，有几个项目存在高度局部依赖性，这影响了最终区分参数的估计。因此，“疼痛对社交活动乐趣的干扰程度如何？”这一项目在所有亚组比较的DIF分析中被排除。没有项目被假设为在种族和民族方面显示出DIF；然而，在主要分析和敏感性分析中进行多重比较调整后，有五个项目显示出DIF：注意力集中能力、娱乐活动乐趣、离家任务、参与社交活动以及与他人交往。DIF的大小较小且影响可忽略不计。有三个项目在教育程度方面始终被确定存在DIF：生活乐趣、注意力集中能力以及娱乐活动乐趣。没有项目显示出高于大小阈值的DIF，且DIF对总体测量的影响最小。在主要分析中进行多重比较校正后，没有项目显示出性别DIF。有四个项目在年龄方面显示出一致的DIF：生活乐趣、注意力集中能力、日常活动以及娱乐活动乐趣，均没有高于阈值的主要大小值。以疼痛状态为条件，假设说西班牙语的人在一个项目（生活乐趣）上报告的疼痛干扰较少。DIF研究结果证实了这一假设；然而，大小较小。使用θ（θ）≥1.0的任意截止点对有急性疼痛干扰的受访者进行分类，教育程度组分析中的变化数量最多。有231名受访者（占总样本的4%）在DIF调整后从无急性疼痛干扰的类别变为急性干扰类别。种族/民族亚组的类别没有变化，65至84岁受访者的变化数量较少。
尽管在进行多重比较校正后观察到显著的DIF，但所有DIF的大小和影响都较低。然而，在低教育程度组中观察到了一些个体层面的影响。信度估计值较高。因此，在这个种族多样化样本中检查的PROMIS简表疼痛项目表现相对良好；尽管有一个项目存在问题并从分析中剔除。结论是PROMIS疼痛干扰简表的大多数项目可推荐在种族多样化群体中使用，包括姑息治疗患者以及癌症和慢性病患者。
