Medvedev Oleg N, Turner-Stokes Lynne, Ashford Stephen, Siegert Richard J
Centre of Medical and Health Sciences Education, Auckland University of Technology, 0626 North Shore, 1142 Auckland, New Zealand.
J Rehabil Med. 2018 Feb 28;50(5):428-428. doi: 10.2340/16501977-2324.
To determine whether the UK Functional Assessment Measure (UK FIM+FAM) fits the Rasch model in stroke patients with complex disability and, if so, to derive a conversion table of Rasch-transformed interval level scores.
The sample included a UK multicentre cohort of 1,318 patients admitted for specialist rehabilitation following a stroke. Rasch analysis was conducted for the 30-item scale including 3 domains of items measuring physical, communication and psychosocial functions. The fit of items to the Rasch model was examined using 3 different analytical approaches referred to as "pathways".
The best fit was achieved in the pathway where responses from motor, communication and psychosocial domains were summarized into 3 super-items and where some items were split because of differential item functioning (DIF) relative to left and right hemisphere location (χ2 (10) = 14.48, p = 0.15). Re-scoring of items showing disordered thresholds did not significantly improve the overall model fit.
The UK FIM+FAM with domain super-items satisfies expectations of the unidimensional Rasch model without the need for re-scoring. A conversion table was produced to convert the total scale scores into interval-level data based on person estimates of the Rasch model. The clinical benefits of interval-transformed scores require further evaluation.
确定英国功能评估量表（UK FIM+FAM）是否适用于残疾情况复杂的中风患者的拉施模型，若适用，则得出拉施转换区间水平分数的转换表。
样本包括一个英国多中心队列，共1318名中风后接受专科康复治疗的患者。对包含测量身体、沟通和心理社会功能3个领域项目的30项量表进行拉施分析。使用3种不同的分析方法（称为“路径”）检验项目与拉施模型的拟合度。
在将运动、沟通和心理社会领域的反应汇总为3个超级项目且因相对于左右半球位置的项目功能差异（DIF）而拆分一些项目的路径中，实现了最佳拟合（χ2(10)=14.48，p=0.15）。对显示阈值紊乱的项目重新计分并未显著改善整体模型拟合度。
具有领域超级项目的UK FIM+FAM满足单维拉施模型的期望，无需重新计分。根据拉施模型的个体估计值，制作了一个转换表，将总量表分数转换为区间水平数据。区间转换分数的临床益处需要进一步评估。
