From the Department of Physical Therapy, MGH Institute of Health Professions, Boston, Massachusetts (SG, PG); and Department of Physical Therapy, Simmons University, Boston, Massachusetts (DT).
Am J Phys Med Rehabil. 2023 Jun 1;102(6):481-488. doi: 10.1097/PHM.0000000000002190. Epub 2023 Jan 18.
This study aimed to develop a function, activities, and participation measurement scale using the questions on the National Health and Nutrition Examination Survey (NHANES) by applying item response theory approaches.
This was a cross-sectional study.
Survey data were collected from 2512 participants within the NHANES.
Twenty questions from the NHANES physical functioning section were included. Exploratory and confirmatory factor analyses were conducted to evaluate the factorial structure and model fit of the NHANES instrument. A multidimensional Rasch modeling was used to model the response data after confirming its model fit. To assess validity across subgroups, differential item functioning test was conducted with respect to sex and race using the three-dimensional partial credit model.
Item fit indices indicated a good fit (root-mean-square error of approximation = 0.049, standardized root-mean-square residual = 0.052, Tucker-Lewis index = 0.975). Rasch analysis indicated that "stoop/crouch/kneel," "stand for long periods," and "push/pull large objects" were the three most difficult items, whereas "walk between rooms," "use fork/knife," and "leisure at home" were the easiest. The measure demonstrated good internal consistency overall (Cronbach α = 0.90).
The NHANES function, activities, and participation measure demonstrates sufficient evidence of reliability, internal consistency, and validity in noninstitutionalized community-dwelling population.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.
Upon completion of this article, the reader should be able to (1) Recognize the potential benefits of using validated patient-reported functional outcome measures within the publically available National Health and Nutrition Examination Survey (NHANES) data for rehabilitation research; (2) Describe the process of scale development and validation; (3) Identify item difficulty based on the item difficulty distribution; and (4) Identify the applicability of the measure to different population groups based on differential item functioning.
Advanced.
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
本研究旨在应用项目反应理论方法，利用国家健康和营养检查调查（NHANES）中的问题开发功能、活动和参与度测量量表。
这是一项横断面研究。
NHANES 中共有 2512 名参与者提供了调查数据。
纳入 NHANES 身体功能部分的 20 个问题。进行探索性和验证性因子分析，以评估 NHANES 工具的因子结构和模型拟合度。在确认模型拟合度后，采用多维 Rasch 模型对反应数据进行建模。为了评估在亚组间的有效性，使用三维部分信用模型针对性别和种族进行了差异项目功能测试。
项目拟合指数表明拟合良好（均方根误差逼近值=0.049，标准化均方根残差=0.052，塔克-刘易斯指数=0.975）。Rasch 分析表明，“弯腰/蹲下/跪下”“长时间站立”和“推拉大物体”是最难的三个项目，而“在房间之间行走”“使用叉子/刀子”和“在家休闲”是最容易的项目。该测量在非机构化社区居住人群中总体表现出良好的内部一致性（Cronbach α=0.90）。
NHANES 功能、活动和参与度测量在非机构化社区居住人群中具有足够的可靠性、内部一致性和有效性证据。
要获得 CME 学分：完成在线自我评估活动和评估http://www.physiatry.org/JournalCME。
CME 目标：完成本文后，读者应能够（1）认识到在康复研究中使用经验证的患者报告功能结果测量在公共可用的国家健康和营养检查调查（NHANES）数据中的潜在益处；（2）描述量表开发和验证的过程；（3）根据项目难度分布识别项目难度；（4）根据差异项目功能识别测量的适用性到不同的人群组。
高级。
学术物理治疗医师协会由继续医学教育认证委员会认证，可为医生提供继续医学教育。学术物理治疗医师协会将这项基于期刊的 CME 活动指定为最多 1.0 个 AMA PRA 类别 1 学分 ™。医生只能根据其参与活动的程度申报与其相符的学分。
