CROSS-CULTURAL VALIDITY OF FUNCTIONAL INDEPENDENCE MEASURE ITEMS IN STROKE: A STUDY USING RASCH ANALYSIS
Åsa Lundgren-Nilsson A1, Gunnar Grimby A1, Haim Ring A2, Luigi Tesio A3, Gemma Lawton A4, Anita Slade A4, Massimo Penta A5, Maria Tripolski A2, Fin Biering-Sørensen A6, Jane Carter A7, Crt Marincek A8, Suzanne Phillips A7, Anna Simone A3, Alan Tennant A4
A1 Rehabilitation Medicine Sahlgrenska Academy at Göteborg University Göteborg Sweden
A2 Loewenstein Hospital, Rehabilitation Centre, Raanana Tel Aviv University School of Medicine Israel
A3 Unit of Rehabilitation Research Istituto Auxologico Italiano Milan Italy
A4 Academic Unit of Musculoskeletal and Rehabilitation Medicine University of Leeds UK
A5 Unité de Réadaption et de Médecine Physique Université Catholique de Louvain Bruxelles Belgium
A6 Clinic for Para- and Tetraplegia, The Neuroscience Centre, Rigshospitalet Copenhagen University Hospital Denmark
A7 The Bath Head Injury/Neuro-Rehabilitation Unit Royal National Hospital for Rheumatic Diseases, National Health Services Trust Bath UK
A8 University Institute for Rehabilitation Ljubljana Ljubljana Slovenia
Objective: To analyse cross-cultural validity of the Functional Independence Measure (FIM™) in patients with stroke using the Rasch model. Settings: Thirty-one rehabilitation facilities within 6 different countries in Europe. Participants: A total of 2546 in-patients at admission, median age 63 years. Methods: Data from the FIM™ were evaluated with the Rasch model, using the Rasch analysis package RUMM2020. A detailed analysis of scoring functions of the 7 categories of the FIM items was undertaken prior to testing fit to the model. Categories were re-scored where necessary. Analysis of Differential Item Functioning was undertaken in pooled data for each of the FIM motor and social-cognitive scales, respectively. Results: Disordered thresholds were found on most items when using 7 categories. Fit to the Rasch model varied between countries. Differential Item Functioning was found by country for most items. Adequate fit to the Rasch model was achieved when items were treated as unique for each country and after a few country-specific items were removed. Conclusion: Clinical collected data from FIM for patients with stroke cannot be pooled in its raw form, or compared across countries. Comparisons can be made after adjusting for country-specific Differential Item Functioning, though the adjustments for Differential Item Functioning and rating scales may not generalize to other samples.
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