Tiwari Devashish, Gochyyev Perman
MGH Institute of Health Professions, Boston, MA 02129, USA.
Children (Basel). 2023 Aug 22;10(9):1428. doi: 10.3390/children10091428.
The purpose of this cross-sectional validation study was to evaluate the clinical utility of the DHI-CA by (1) examining its dimensionality using exploratory factor analysis (EFA) and (2) calibrating DHI-CA items (using the multidimensional Rasch model) to obtain item difficulty levels. A retrospective chart review was conducted for 132 patients between the ages of 8 and 18 years (mean age = 15.3 ± 2.1 years) from a multidisciplinary post-concussion management tertiary center. Data were extracted on age, sex, and DHI-CA. EFA revealed that 12 out of 25 items did not fit in the subscale that they were originally described under, indicating poor dimensionality. Calibration of items on the Wright Maps revealed that 50% of the items pooled in the lower difficulty level, indicating a potential ceiling effect. Corrected item-rest correlations for the physical, emotional, walking/mobility, and community participation ranged from 0.44-0.66, 0.27-0.61, 0.54-0.57, and 0.32-0.69 ( < 0.001), respectively. The clinical utility of the DHI-CA was found to be questionable due to the presence of double-barreled items and the ceiling effect. Clinicians must supplement data from the DHI-CA with other measures and patient interviews to make informed clinical decisions specific to the post-concussion population until new, robust, and valid measures are developed.
这项横断面验证研究的目的是评估脑震荡后健康状况调查问卷-儿童版（DHI-CA）的临床效用，具体方法为：（1）使用探索性因子分析（EFA）检验其维度；（2）校准DHI-CA项目（使用多维Rasch模型）以获得项目难度水平。对一家多学科脑震荡后管理三级中心的132名8至18岁患者（平均年龄 = 15.3 ± 2.1岁）进行了回顾性病历审查。提取了年龄、性别和DHI-CA的数据。EFA显示，25个项目中有12个不符合其最初所属的子量表，表明维度不佳。Wright图上项目的校准显示，50%的项目集中在较低难度水平，表明存在潜在的天花板效应。身体、情绪、行走/移动和社区参与方面的校正项目-剩余相关系数分别为0.44 - 0.66、0.27 - 0.61、0.54 - 0.57和0.32 - 0.69（<0.001）。由于存在双管项目和天花板效应，DHI-CA的临床效用存疑。在开发出新的、可靠且有效的测量方法之前，临床医生必须用其他测量方法和患者访谈来补充DHI-CA的数据，以便针对脑震荡后人群做出明智的临床决策。
