Esakki Saravanan, MacDermid Joy C, Vincent Joshua I, Packham Tara L, Walton David, Grewal Ruby
1School of Physical Therapy, Western University, London, ON Canada.
3The Hand and Upper Limb Centre, St Joseph's Health Centre, London, ON Canada.
Arch Physiother. 2018 Feb 26;8:5. doi: 10.1186/s40945-018-0046-z. eCollection 2018.
The Patient-Rated Wrist Evaluation (PRWE) was developed as a wrist joint specific measure of pain and disability and evidence of sound validity has been accumulated through classical psychometric methods. Rasch analysis (RA) has been endorsed as a newer method for analyzing the clinical measurement properties of self-report outcome measures. The purpose of this study was to evaluate the PRWE using Rasch modeling.
We employed the Rasch model to assess overall fit, response scaling, individual item fit, differential item functioning (DIF), local dependency, unidimensionality and person separation index (PSI). A convenience sample of 382 patients with distal radius fracture was recruited from the hand and upper limb clinic at large academic healthcare organization, London, Ontario, Canada, 6-month post-injury scores of the PRWE was used. RA was conducted on the 3 subscales (pain, specific activities, and usual activities) of the PRWE separately.
The pain subscale adequately fit the Rasch model when item 4 "Pain - When it is at its worst" was deleted to eliminate non-uniform DIF by age group, and item 5 "How often do you have pain" was rescored by collapsing into 8 intervals to eliminate disordered thresholds. Uniform DIF for "Use my affected hand to push up from the chair" (by work status) and "Use bathroom tissue with my affected hand" (by injured hand) was addressed by splitting the items for analysis. After background rescoring of 2 items in pain subscale, 2 items in specific activities and 3 items in usual activities, all three subscales of the PRWE were well targeted and had high reliability (PSI = 0.86). These changes provided a unidimensional, interval-level scaled measure.
Like a previous analysis of the Patient-Rated Wrist and Hand Evaluation, this study found the PRWE could be fit to the Rasch model with rescoring of multiple items. However, the modifications required to achieve fit were not the same across studies, our fit statistics also suggested one of the pain items should be deleted. This study adds to the pool of evidence supporting the PRWE, but cannot confidently provide a Rasch-based scoring algorithm.
患者自评腕关节评估量表（PRWE）是作为一种针对腕关节疼痛和功能障碍的特定测量工具而开发的，并且通过经典心理测量方法积累了其效度良好的证据。拉施分析（RA）已被认可为一种用于分析自我报告结局测量临床测量特性的更新方法。本研究的目的是使用拉施模型评估PRWE。
我们采用拉施模型来评估整体拟合度、反应尺度、单个项目拟合度、项目功能差异（DIF）、局部依赖性、单维度性和人员分离指数（PSI）。从加拿大安大略省伦敦市一家大型学术医疗保健机构的手和上肢诊所招募了382例桡骨远端骨折患者的便利样本，使用PRWE伤后6个月的评分。对PRWE的3个分量表（疼痛、特定活动和日常活动）分别进行拉施分析。
当删除项目4“疼痛 - 最严重时”以消除年龄组的非均匀DIF，并将项目5“您多久疼痛一次”重新计分合并为8个区间以消除无序阈值时，疼痛分量表充分拟合拉施模型。通过拆分项目进行分析解决了“用患手从椅子上撑起身体”（按工作状态）和“用患手使用卫生纸”（按受伤手）的均匀DIF问题。在对疼痛分量表中的2个项目、特定活动中的2个项目和日常活动中的3个项目进行背景重新计分后，PRWE的所有三个分量表都具有良好的针对性和高信度（PSI = 0.86）。这些变化提供了一种单维度、区间水平的量表测量方法。
与之前对患者自评腕关节和手部评估的分析一样，本研究发现PRWE通过对多个项目重新计分可以拟合拉施模型。然而，不同研究实现拟合所需的修改并不相同，我们的拟合统计数据还表明应删除其中一个疼痛项目。本研究增加了支持PRWE的证据，但无法自信地提供基于拉施的计分算法。
