Director, UK Rehabilitation Outcomes Collaborative, Northwick Park Hospital and King's College London, London, United Kingdom.
J Rehabil Med. 2019 Sep 3;51(8):566-574. doi: 10.2340/16501977-2580.
To determine whether the UK Functional Assessment Measure (UK FIM+FAM) fits the Rasch model in patients with complex disability following traumatic brain injury.
Psychometric evaluation including preliminary exploratory and confirmatory factor analyses followed by Rasch analysis.
A multicentre UK national cohort of 1,956 patients admitted for specialist rehabilitation following traumatic brain injury.
The suitability of the Partial Credit Model was confirmed by the likelihood-ratio test (χ2 (df86) =7,325.0, p < 0.001). Exploratory and confirmatory factor analyses supported 3 factors (Motor, Communication, Psychosocial). Rasch analysis of the full scale incorporating the 3 factors as super-items resulted in an acceptable overall model fit (χ2 (df24)=36.72, p = 0.05) and strict uni-dimensionality when tested on a sub-sample of n = 320. These results were replicated in a full sample (n = 1,956) showing uni-dimensionality and good reliability with Person Separation Index = 0.81, but item trait interaction was significant due to the large sample size. No significant differential item functioning was observed for any personal factors. Neither uniform re-scoring of items nor exclusion of participants with extreme scores improved the model fit.
The UK FIM+FAM scale satisfies the Rasch model reasonably in traumatic brain injury. A conversion table was produced, but its usefulness in clinical practice requires further exploration and clinical translation.
确定 UK Functional Assessment Measure（UK FIM+FAM）是否适用于创伤性脑损伤后复杂残疾患者。
包括初步探索性和验证性因子分析，然后进行 Rasch 分析的心理计量学评估。
一项来自英国的多中心研究，纳入了 1956 名因创伤性脑损伤接受专科康复治疗的患者。
似然比检验（χ2（df86）=7325.0，p<0.001）证实了部分信用模型的适宜性。探索性和验证性因子分析支持 3 个因素（运动、沟通、心理社会）。将 3 个因素作为超项纳入全量表的 Rasch 分析得出了可接受的总体模型拟合度（χ2（df24）=36.72，p=0.05），在 n=320 的子样本上测试时具有严格的单维性。这些结果在 n=1956 的全样本中得到了复制，表现出单维性和良好的可靠性，个体分离指数为 0.81，但由于样本量大，项目特征交互作用显著。没有观察到任何个人因素的显著差异项目功能。重新评分项目或排除极端分数的参与者都没有改善模型拟合度。
UK FIM+FAM 量表在创伤性脑损伤中基本符合 Rasch 模型。生成了一个转换表，但在临床实践中的实用性需要进一步探索和临床转化。
