Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden.
Angered Hospital, Box 63, 422 24, Gothenburg, Sweden.
Health Qual Life Outcomes. 2022 Feb 19;20(1):30. doi: 10.1186/s12955-022-01937-7.
The Swedish version of the patient-reported Clinical Outcomes in Routine Evaluation Outcome Measures (CORE-OM) has demonstrated high reliability and acceptable convergent validity in explanatory factor analyses. However, the fundamental scale properties have not yet been validated according to item response theory. The aim of this study was to analyze the measurement properties of the Swedish CORE-OM in a cohort of psychiatric out-patients with depression and anxiety in a multicultural area and to explore combinations of items based on shorter versions of the scale (CORE-10, CORE-6D) to improve measurement properties.
Data from CORE-OM assessments of 337 patients were analyzed using Rasch analysis. The patients had a mean age of 30 ± 14 years, the majority were women (72%). Requirements for measurement properties were checked: overall model fit, item fit residuals, targeting, internal consistency, differential item functioning and thresholds. Sensitivity to change was also analyzed.
The CORE-OM showed high internal consistency (person separation index = 0.947) and adequate targeting, but there was overall model misfit (item trait interaction χ = 917.53, p < 0.001), indication of local dependency, and differential item functioning in 9 items. The risk items showed problems with disordered thresholds. The emotional component of the shorter CORE-6D showed the best fit for our sample. Adding 3 items to include depressive and trauma-related content resulted in a unidimensional 8-item set with acceptable reliability, model fit, targeting and sensitivity to change.
For out-patients with diagnosed depression or anxiety in a multicultural area, the Swedish CORE-OM showed high internal consistency, but also validity problems. Based on the shorter CORE-6D version, a unidimensional 8-item set could be an alternative brief measure of psychological distress for this population, but further validity studies are required. Qualitative studies exploring the CORE-OM items in non-native speakers are also warranted.
瑞典版患者报告的常规评估结果测量（CORE-OM）在解释性因子分析中表现出了较高的可靠性和可接受的收敛效度。然而，根据项目反应理论，其基本量表属性尚未得到验证。本研究的目的是在一个多文化地区的精神科门诊抑郁和焦虑患者队列中分析瑞典 CORE-OM 的测量特性，并探索基于较短版本量表（CORE-10、CORE-6D）的项目组合，以改善测量特性。
使用 Rasch 分析对 337 名患者的 CORE-OM 评估数据进行分析。患者的平均年龄为 30±14 岁，大多数为女性（72%）。检查了测量特性的要求：整体模型拟合、项目拟合残差、目标值、内部一致性、区分项目功能和阈值。还分析了敏感性变化。
CORE-OM 显示出较高的内部一致性（个体分离指数=0.947）和适当的目标值，但总体模型拟合不良（项目特征交互 χ=917.53，p<0.001），存在局部依赖性，9 个项目存在区分项目功能。风险项目显示出阈值紊乱的问题。较短的 CORE-6D 的情感成分最适合我们的样本。增加 3 个项目以包含抑郁和创伤相关内容，得到了一个具有可接受的可靠性、模型拟合、目标值和对变化敏感的 8 项单维集。
对于在多文化地区诊断为抑郁或焦虑的门诊患者，瑞典版 CORE-OM 显示出较高的内部一致性，但也存在有效性问题。基于较短的 CORE-6D 版本，一个单维的 8 项集可能是该人群心理困扰的一种替代简短测量方法，但需要进一步的有效性研究。探索非母语人士 CORE-OM 项目的定性研究也是必要的。
