Content » Vol 52, Issue 10

Original report

Cross-diagnostic scale-banking using rasch analysis: Developing a common reference metric for generic and health condition-specific scales in people with rheumatoid arthritis and stroke

Birgit Prodinger, Ayşe A. Küçükdeveci, Sehim Kutlay, Atilla H. Elhan, Svend Kreiner, Alan Tennant
Faculty of Applied Health and Social Sciences, Technical University of Applied Sciences Rosenheim, Rosenheim, Germany. E-mail:
DOI: 10.2340/16501977-2736


Objectives: To develop a common reference metric of functioning, incorporating generic and health condition-specific disability instruments, and to test whether this reference metric is invariant across 2 health conditions.
Design: Psychometric study using secondary data analysis. Firstly, the International Classification of Functioning, Disability and Health (ICF) Linking Rules were used to examine the concept equivalence between the World Health Organization Disability Assessment Schedule (WHODAS 2. 0), Health Assessment Questionnaire (HAQ) and Functional Independence Measure (FIMTM). Secondly, a scale-bank was developed using a reference metric approach to test-equating, based on the Rasch measurement model.
Participants: Secondary analysis was performed on data from 487 people; 61. 4% with rheumatoid arthritis and 38. 6% with stroke.
Results: Three sub-domains of the WHODAS 2. 0 and all items of the HAQ and FIMTM motor mapped on to the ICF chapters d4 Mobility, d5 Self-care and d6 Domestic life. Test-equating of these scales resulted in good model fit, indicating that a scale bank and associated reference metric across these 3 instruments could be created.
Conclusion: This study provides a transformation table to enable direct comparisons among instruments measuring physical functioning commonly used in rheumatoid arthritis (HAQ) and stroke (FIMTM motor scale), as well as in people with disability in general (WHODAS 2. 0).

Lay Abstract

Functioning is what matters most to people with chronic
health conditions, such as stroke or rheumatoid arthritis. While medical signs and symptoms related to these health conditions may vary widely, research has shown that people may experience similar problems with func-tioning. Therefore, being able to monitor and compare functioning over time is essential for the planning and allocation of rehabilitation. This study provides evidence that a common measure can be created, based on a single general disability instrument and 2 health condition-specific instruments. For clinical practice this implies that standardized reporting of functioning can be achieved based on a common measure, while data collection can continue using the commonly used and established instruments.


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