Deutscher Daniel, Hayes Deanna, Kallen Michael A
Net Health Systems, Inc, Pittsburgh, PA.
Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel.
Arch Rehabil Res Clin Transl. 2024 Jan 5;6(1):100320. doi: 10.1016/j.arrct.2024.100320. eCollection 2024 Mar.
To calibrate the 25 items from the Dizziness Handicap Inventory (DHI) patient-reported outcome measure (PROM), using item response theory (IRT), into 1 or more item banks, and assess reliability, validity, and administration efficiency of scores derived from computerized adaptive test (CAT) or short form (SF) administration modes.
Retrospective cohort study.
Outpatient rehabilitation clinics.
Patients (N=28,815; women=69%; mean age [SD]=60 [18]) included in a large national dataset and assessed for dizziness-related conditions who responded to all DHI items at intake.
Not applicable.
IRT model assumptions of unidimensionality, local item independence, item fit, and presence of differential item functioning (DIF) were evaluated. Generated scores were assessed for reliability, validity, and administration efficiency.
Patients were treated in 976 clinics from 49 US states for either vestibular-, brain injury-, or neck-related impairments. Three unidimensional item banks were calibrated, creating 3 distinct PROMs for Dizziness Functional Status (DFS, 13 items), Dizziness Positional Status (DPS, 4 items), and Dizziness Emotional Status (DES, 6 items). Two items did not fit into any domain. A DFS-CAT and a DFS 7-item SF were developed. Except for 2 items by age groups and 1 item by main impairment, no items were flagged for DIF; DIF impact was negligible. Median reliability estimates were 0.91, 0.72, and 0.79 for the DFS, DPS, and DES, respectively. Scores discriminated between patient groups in clinically logical ways and had a large effect size (>0.8), with acceptable floor and ceiling effects (<15%), except for a floor effect for DPS (20.4%). DFS-CAT scores were generated using a median of 8 items; they correlated highly with full-bank scores (=0.99).
The 3 dizziness impact PROMs demonstrated moderate to high reliability, were valid, and highly responsive to change; thus, they are suitable for research and routine clinical administration.
运用项目反应理论（IRT），将头晕残障量表（DHI）患者报告结局测量（PROM）中的25个条目校准到1个或多个条目库中，并评估源自计算机自适应测试（CAT）或简表（SF）施测模式的分数的信度、效度和施测效率。
回顾性队列研究。
门诊康复诊所。
纳入一个大型国家数据集且在初次就诊时对所有DHI条目做出回应、接受头晕相关疾病评估的患者（N = 28815；女性占69%；平均年龄[标准差]= 60 [18]）。
不适用。
评估IRT模型的单维性、局部项目独立性、项目拟合以及差异项目功能（DIF）存在的假设。对生成的分数进行信度、效度和施测效率评估。
患者在美国49个州的976家诊所接受前庭、脑损伤或颈部相关损伤的治疗。校准了3个单维条目库，为头晕功能状态（DFS，13个条目）、头晕位置状态（DPS，4个条目）和头晕情绪状态（DES，6个条目）创建了3个不同的PROM。有2个条目不属于任何领域。开发了一个DFS - CAT和一个DFS 7条目简表。除了按年龄组划分的2个条目和按主要损伤划分的1个条目外，没有条目被标记为存在DIF；DIF的影响可忽略不计。DFS、DPS和DES的信度中位数估计分别为0.91、0.72和0.79。分数以临床合理的方式区分患者组，效应量较大（> 0.8），地板效应和天花板效应可接受（< 15%），除了DPS的地板效应为20.4%。DFS - CAT分数使用中位数8个条目生成；它们与完整条目库分数高度相关（= 0.99）。
这3种头晕影响PROM显示出中度到高度的信度，有效且对变化反应灵敏；因此，它们适用于研究和常规临床应用。
