Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.
Health Qual Life Outcomes. 2021 Jan 6;19(1):6. doi: 10.1186/s12955-020-01643-2.
Disability is an increasingly important health-related outcome to consider as more individuals are now aging with Human Immunodeficiency Virus (HIV) and multimorbidity. The HIV Disability Questionnaire (HDQ) is a patient-reported outcome measure (PROM), developed to measure the presence, severity and episodic nature of disability among adults living with HIV. The 69-item HDQ includes six domains: physical, cognitive, mental-emotional symptoms and impairments, uncertainty and worrying about the future, difficulties with day-to-day activities, and challenges to social inclusion. Our aim was to develop a short-form version of the HIV Disability Questionnaire (SF-HDQ) to facilitate use in clinical and community-based practice among adults living with HIV.
We used Rasch analysis to inform item reduction using an existing dataset of adults living with HIV in Canada (n = 941) and Ireland (n = 96) who completed the HDQ (n = 1037). We evaluated overall model fit with Cronbach's alpha and Person Separation Indices (PSIs) (≥ 0.70 acceptable). Individual items were evaluated for item threshold ordering, fit residuals, differential item functioning (DIF) and unidimensionality. For item threshold ordering, we examined item characteristic curves and threshold maps merging response options of items with disordered thresholds to obtain order. Items with fit residuals > 2.5 or less than - 2.5 and statistically significant after Bonferroni-adjustment were considered for removal. For DIF, we considered removing items with response patterns that varied according to country, age group (≥ 50 years versus < 50 years), and gender. Subscales were considered unidimensional if ≤ 5% of t-tests comparing possible patterns in residuals were significant.
We removed 34 items, resulting in a 35-item SF-HDQ with domain structure: physical (10 items); cognitive (3 items); mental-emotional (5 items); uncertainty (5 items); difficulties with day-to-day activities (5 items) and challenges to social inclusion (7 items). Overall models' fit: Cronbach's alphas ranged from 0.78 (cognitive) to 0.85 (physical and mental-emotional) and PSIs from 0.69 (day-to-day activities) to 0.79 (physical and mental-emotional). Three items were rescored to achieve ordered thresholds. All domains demonstrated unidimensionality. Three items with DIF were retained because of their clinical importance.
The 35-item SF-HDQ offers a brief, comprehensive disability PROM for use in clinical and community-based practice with adults living with HIV.
随着越来越多的人感染人类免疫缺陷病毒（HIV）并患有多种疾病，残疾已成为一个日益重要的健康相关结果。HIV 残疾问卷（HDQ）是一种患者报告的结局测量工具（PROM），旨在衡量感染 HIV 的成年人的残疾的存在、严重程度和发作性质。该 69 项 HDQ 包括六个领域：身体、认知、精神情绪症状和障碍、对未来的不确定性和担忧、日常生活活动困难以及社会包容挑战。我们的目的是开发一种 HIV 残疾问卷的简短形式（SF-HDQ），以促进在感染 HIV 的成年人的临床和社区实践中使用。
我们使用 Rasch 分析来告知使用加拿大（n=941）和爱尔兰（n=96）现有 HIV 感染者数据集进行项目缩减，这些人完成了 HDQ（n=1037）。我们使用 Cronbach's alpha 和个体分离指数（PSI）（≥0.70 可接受）评估整体模型拟合度。对个体项目进行项目阈值排序、拟合残差、差异项目功能（DIF）和单维性评估。对于项目阈值排序，我们检查项目特征曲线和阈值图，将具有无序阈值的项目的响应选项合并，以获得顺序。对于拟合残差大于 2.5 或小于-2.5 且经过 Bonferroni 校正后具有统计学意义的项目，我们考虑将其删除。对于 DIF，我们考虑删除根据国家、年龄组（≥50 岁与<50 岁）和性别而变化的反应模式的项目。如果比较残差可能模式的 t 检验中≤5%的模式具有统计学意义，则认为子量表具有单维性。
我们删除了 34 个项目，得到了一个 35 项的 SF-HDQ，具有以下领域结构：身体（10 项）；认知（3 项）；精神情绪（5 项）；不确定性（5 项）；日常活动困难（5 项）和社会包容挑战（7 项）。总体模型拟合度：Cronbach's alphas 范围从 0.78（认知）到 0.85（身体和精神情绪），PSI 从 0.69（日常活动）到 0.79（身体和精神情绪）。三个项目被重新评分以实现有序阈值。所有领域都表现出单维性。由于其临床重要性，保留了三个具有 DIF 的项目。
35 项 SF-HDQ 为感染 HIV 的成年人提供了一种简短、全面的残疾 PROM，可用于临床和社区实践。
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