Rasch validation of a new scale to measure dependency in arm use in daily life: the Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale
IntroductionAbout 77% of adults with stroke have upper limb impairments. Many scales are available to measure the impairment and activity level of the affected limb. However, an observational scale to assess dependency on others in upper limb performance during daily life activities instead of labor...
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Frontiers Media S.A.
2023-07-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1154322/full |
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| author | Ann Van de Winckel Beatrice Ottiger Janne Marieke Veerbeek Thomas Nyffeler Thomas Nyffeler Thomas Nyffeler Tim Vanbellingen Tim Vanbellingen |
| author_facet | Ann Van de Winckel Beatrice Ottiger Janne Marieke Veerbeek Thomas Nyffeler Thomas Nyffeler Thomas Nyffeler Tim Vanbellingen Tim Vanbellingen |
| author_sort | Ann Van de Winckel |
| collection | DOAJ |
| description | IntroductionAbout 77% of adults with stroke have upper limb impairments. Many scales are available to measure the impairment and activity level of the affected limb. However, an observational scale to assess dependency on others in upper limb performance during daily life activities instead of laboratory settings is lacking. Therefore, we developed a new 5-item Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale (UL-LIMOS). As next step in the psychometric analysis, we evaluated the unidimensionality and structural validity of the UL-LIMOS with Rasch Measurement Theory and we calculated a cut-off score for independent arm use in daily life activities at discharge.MethodsThis is a single-center cross-sectional study in adults with (sub) acute stroke. We applied Rasch Measurement Theory (RMT) to analyze the structural validation and unidimensionality of the UL-LIMOS. The outputs provide evidence of unidimensionality, item and person fit, overall fit, differential item functioning (DIF), principal component analysis of residuals (PCAR), person separation reliability (PSR), and residual item correlations (to identify local item dependence). Person mean location, floor and ceiling effects identify proper targeting.ResultsWe recruited 407 adults with (sub) acute stroke (median age 63 years, 157 women). All items and persons fit the Rasch model. The PSR of 0.90 indicates that clinicians and researchers can reliably use the scale for individual decision-making. There were small floor (2.70%) and ceiling (13.00%) effects. The average person mean location was 1.32 ± 2.99 logits. There was no DIF. PCAR eigenvalue was 2.46 with 49.23% explained variance. Paired t-tests revealed that 0.89% of person locations were significantly different, confirming unidimensionality. One pair of items (arm and hand use and fine hand use) showed residual item correlations. The ROC’s AUC was 0.90, CI95% = [0.85–0.96] with cut-off score of ≥14/20, and high sensitivity (87%, CI95% = [81%–91%]), specificity (83%, CI95% = [77%–87%]) for independent arm use in daily living at discharge.DiscussionThe new Rasch-based UL-LIMOS is a valid ICF-based observation performance scale at the ICF-activity level, to evaluate dependency during upper limb use in daily life in adults with stroke. Additional psychometric analyses are warranted. The UL-LIMOS would be a valuable addition to the core assessments of adults with (sub) acute stroke. |
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| spelling | doaj.art-dd621996a3134889ad63c8bd5746a34d2023-07-10T12:27:51ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-07-011410.3389/fneur.2023.11543221154322Rasch validation of a new scale to measure dependency in arm use in daily life: the Upper Limb Lucerne ICF-based Multidisciplinary Observation ScaleAnn Van de Winckel0Beatrice Ottiger1Janne Marieke Veerbeek2Thomas Nyffeler3Thomas Nyffeler4Thomas Nyffeler5Tim Vanbellingen6Tim Vanbellingen7Brain Body Mind Laboratory, Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United StatesNeurocenter, Luzerner Kantonsspital, Lucerne, SwitzerlandNeurocenter, Luzerner Kantonsspital, Lucerne, SwitzerlandNeurocenter, Luzerner Kantonsspital, Lucerne, SwitzerlandARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, SwitzerlandDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandNeurocenter, Luzerner Kantonsspital, Lucerne, SwitzerlandARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, SwitzerlandIntroductionAbout 77% of adults with stroke have upper limb impairments. Many scales are available to measure the impairment and activity level of the affected limb. However, an observational scale to assess dependency on others in upper limb performance during daily life activities instead of laboratory settings is lacking. Therefore, we developed a new 5-item Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale (UL-LIMOS). As next step in the psychometric analysis, we evaluated the unidimensionality and structural validity of the UL-LIMOS with Rasch Measurement Theory and we calculated a cut-off score for independent arm use in daily life activities at discharge.MethodsThis is a single-center cross-sectional study in adults with (sub) acute stroke. We applied Rasch Measurement Theory (RMT) to analyze the structural validation and unidimensionality of the UL-LIMOS. The outputs provide evidence of unidimensionality, item and person fit, overall fit, differential item functioning (DIF), principal component analysis of residuals (PCAR), person separation reliability (PSR), and residual item correlations (to identify local item dependence). Person mean location, floor and ceiling effects identify proper targeting.ResultsWe recruited 407 adults with (sub) acute stroke (median age 63 years, 157 women). All items and persons fit the Rasch model. The PSR of 0.90 indicates that clinicians and researchers can reliably use the scale for individual decision-making. There were small floor (2.70%) and ceiling (13.00%) effects. The average person mean location was 1.32 ± 2.99 logits. There was no DIF. PCAR eigenvalue was 2.46 with 49.23% explained variance. Paired t-tests revealed that 0.89% of person locations were significantly different, confirming unidimensionality. One pair of items (arm and hand use and fine hand use) showed residual item correlations. The ROC’s AUC was 0.90, CI95% = [0.85–0.96] with cut-off score of ≥14/20, and high sensitivity (87%, CI95% = [81%–91%]), specificity (83%, CI95% = [77%–87%]) for independent arm use in daily living at discharge.DiscussionThe new Rasch-based UL-LIMOS is a valid ICF-based observation performance scale at the ICF-activity level, to evaluate dependency during upper limb use in daily life in adults with stroke. Additional psychometric analyses are warranted. The UL-LIMOS would be a valuable addition to the core assessments of adults with (sub) acute stroke.https://www.frontiersin.org/articles/10.3389/fneur.2023.1154322/fulloutcomeRasch Measurement TheoryRasch analysisupper limbdisabilityhealth |
| spellingShingle | Ann Van de Winckel Beatrice Ottiger Janne Marieke Veerbeek Thomas Nyffeler Thomas Nyffeler Thomas Nyffeler Tim Vanbellingen Tim Vanbellingen Rasch validation of a new scale to measure dependency in arm use in daily life: the Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale Frontiers in Neurology outcome Rasch Measurement Theory Rasch analysis upper limb disability health |
| title | Rasch validation of a new scale to measure dependency in arm use in daily life: the Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale |
| title_full | Rasch validation of a new scale to measure dependency in arm use in daily life: the Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale |
| title_fullStr | Rasch validation of a new scale to measure dependency in arm use in daily life: the Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale |
| title_full_unstemmed | Rasch validation of a new scale to measure dependency in arm use in daily life: the Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale |
| title_short | Rasch validation of a new scale to measure dependency in arm use in daily life: the Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale |
| title_sort | rasch validation of a new scale to measure dependency in arm use in daily life the upper limb lucerne icf based multidisciplinary observation scale |
| topic | outcome Rasch Measurement Theory Rasch analysis upper limb disability health |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1154322/full |
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