Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Health and Quality of Life Outcomes
Published in: Health and Quality of Life Outcomes 1/2006

Open Access 01-12-2006 | Research

Cross-diagnostic validity in a generic instrument: an example from the Functional Independence Measure in Scandinavia

Authors: Å Lundgren-Nilsson, A Tennant, G Grimby, KS Sunnerhagen

Published in: Health and Quality of Life Outcomes | Issue 1/2006

Login to get access

Abstract

Background

To analyse the cross-diagnostic validity of the Functional Independence Measure (FIM™) motor items in patients with spinal cord injury, stroke and traumatic brain injury and the comparability of summed scores between these diagnoses.

Methods

Data from 471 patients on FIM™ motor items at admission (stroke 157, spinal cord injury 157 and traumatic brain injury 157), age range 11–90 years and 70 % male in nine rehabilitation facilities in Scandinavia, were fitted to the Rasch model. A detailed analysis of scoring functions of the seven categories of the FIM™ motor items was made prior to testing fit to the model. Categories were re-scored where necessary. Fit to the model was assessed initially within diagnosis and then in the pooled data. Analysis of Differential Item Functioning (DIF) was undertaken in the pooled data for the FIM™ motor scale. Comparability of sum scores between diagnoses was tested by Test Equating.

Results

The present seven category scoring system for the FIM™ motor items was found to be invalid, necessitating extensive rescoring. Despite rescoring, the item-trait interaction fit statistic was significant and two individual items showed misfit to the model, Eating and Bladder management. DIF was also found for Spinal Cord Injury, compared with the other two diagnoses. After adjustment, it was possible to make appropriate comparisons of sum scores between the three diagnoses.

Conclusion

The seven-category response function is a problem for the FIM™ instrument, and a reduction of responses might increase the validity of the instrument. Likewise, the removal of items that do not fit the underlying trait would improve the validity of the scale in these groups. Cross-diagnostic DIF is also a problem but for clinical use sum scores on group data in a generic instrument such as the FIM™ can be compared with appropriate adjustments. Thus, when planning interventions (group or individual), developing rehabilitation programs or comparing patient achievements in individual items, cross-diagnostic DIF must be taken into account.
Appendix
Available only for authorised users
Literature
1.
Streiner DL, Norman GR: Health measurement scales : a practical guide to their development and use. In Oxford medical publications. 2nd edition. Oxford ; New York , Oxford University Press; 1995:viii, 231.
2.
Haigh R, Tennant A, Biering-Sorensen F, Grimby G, Marincek C, Phillips S, Ring H, Tesio L, Thonnard JL: The use of outcome measures in physical medicine and rehabilitation within Europe. J Rehabil Med 2001,33(6):273–278. 10.1080/165019701753236464PubMedCrossRef
3.
Beaton DE, Bombardier C, Guillemin F, Ferraz MB: Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 2000,25(24):3186–3191. 10.1097/00007632-200012150-00014PubMedCrossRef
4.
Tennant A, Penta M, Tesio L, Grimby G, Thonnard JL, Slade A, Lawton G, Simone A, Carter J, Lundgren-Nilsson A, Tripolski M, Ring H, Biering-Sorensen F, Marincek C, Burger H, Phillips S: Assessing and adjusting for cross-cultural validity of impairment and activity limitation scales through differential item functioning within the framework of the Rasch model: the PRO-ESOR project. Med Care 2004,42(1 Suppl):I37–48.PubMed
5.
Hamilton B, Granger C, Sherwin FS, Zielezny M, Tashman JS: A Uniform National Data System for Medical Rehabilitation. In Rehabilitation outcomes : analysis and measurement. Edited by: Fuhrer MJ. Baltimore , Brookes; 1987:137–147.
6.
Deutsch A, Braun S, Granger C: The Functional Independence Measure (FIMSM Instrument) and the Functional Independence Measure for Children (WeeFIMR ): ten years of development. Crit Rev Phys Med Rehabil 1996, 8: 267–281.
7.
Cohen ME, Marino RJ: The tools of disability outcomes research functional status measures. Arch Phys Med Rehabil 2000,81(12 Suppl 2):S21–9. 10.1053/apmr.2000.20620PubMedCrossRef
8.
Lundgren-Nilsson A, Grimby G, Ring H, Tesio L, Lawton G, Slade A, Penta M, Tripolski M, Biering-Sorensen F, Carter J, Marincek C, Phillips S, Simone A, Tennant A: Cross-cultural validity of Functional Independence Measure items in stroke:A study using Rasch analysis. J Rehabil Med 2005,37(1):23–31. 10.1080/16501970410032696PubMedCrossRef
9.
Dallmeijer AJ, Dekker J, Roorda LD, Knol DL, van Baalen B, de Groot V, Schepers VP, Lankhorst GJ: Differential item functioning of the Functional Independence Measure in higher performing neurological patients. J Rehabil Med 2005,37(6):346–352. 10.1080/16501970510038284PubMedCrossRef
10.
Keith RA: Functional assessment measures in medical rehabilitation: current status. Arch Phys Med Rehabil 1984,65(2):74–78.PubMed
11.
Linacre JM, Heinemann AW, Wright BD, Granger CV, Hamilton BB: The structure and stability of the Functional Independence Measure [see comments]. Arch Phys Med Rehabil 1994,75(2):127–132.PubMed
12.
Rasch G: Probabilistic models for some intelligence and attainment tests. Expanded edition. Chicago , University of Chicago Press; 1980:xxiii, 199.
13.
Masters GN: A Rasch model for parital credit scoring. Psychometrica 1982, 47: 149–174. 10.1007/BF02296272CrossRef
14.
van Alphen A, Halfens R, Hasman A, Imbos T: Likert or Rasch? Nothing is more applicable than good theory. J Adv Nurs 1994,20(1):196–201. 10.1046/j.1365-2648.1994.20010196.xPubMedCrossRef
15.
Wright BD, Masters GN: Rating scale analysis. Chicago , Mesa Press; 1982:xi, 206.
16.
17.
Fisher WP: Reilability statistics. Rasch Measurement Transactions 1992,6(3):238.
18.
Smith RM: Fit analysis in latent trait measurement models. J Appl Meas 2000,1(2):199–218.PubMed
19.
Dorans NJ, Holland PW: DIF detection and description: Mantel-Haenszel and standardisation. In Differential item functioning : theory and practice. Edited by: Holland PW, Wainer H. Hillsdale , Lawrence Erlbaum Associates; 1993:36–66.
20.
Orlando M, Marshall GN: Differential item functioning in a Spanish translation of the PTSD checklist: detection and evaluation of impact. Psychol Assess 2002,14(1):50–59. 10.1037/1040-3590.14.1.50PubMedCrossRef
21.
Elhan AH, Kutlay S, Kucukdeveci AA, Cotuk C, Ozturk G, Tesio L, Tennant A: Psychometric properties of the Mini-Mental State Examination in patients with acquired brain injury in Turkey. J Rehabil Med 2005,37(5):306–311. 10.1080/16501970510037573PubMedCrossRef
22.
Lawton G, Lundgren-Nilsson A, Biering-Sorensen F, Tesio L, Slade A, Penta M, Grimby G, Ring H, Tennant A: Cross-cultural validity of FIM in spinal cord injury. Spinal Cord 2006.
23.
Pallant JFTA: An introduction to the Rasch measurement model: An example using the Hospital Anxiety and Depression Scale (HADS). British Journal of Clinical Psychology 2006.
24.
Bond TG, Fox CM: Applying the Rasch model : fundamental measurement in the human sciences. Mahwah, N.J. , L. Erlbaum; 2001:xxiv, 255.
25.
Wright BD: Rack and Stack: Time 1 vs. Time 2. Rasch Measurement Transactions 2003,17(1):905–906.
26.
Andrich D, Luo G: Conditional pairwise estimation in the Rasch model for ordered response categories using principal components. J Appl Meas 2003,4(3):205–221.PubMed
27.
Luo G, Andrich D: Estimating parameters in the Rasch model in the presence of null categories. J Appl Meas 2005,6(2):128–146.PubMed
28.
van Buuren S, Eyres S, Tennant A, Hopman-Rock M: Assessing comparability of dressing disability in different countries by response conversion. Eur J Public Health 2003,13(3 Suppl):15–19. 10.1093/eurpub/13.suppl_1.15PubMedCrossRef
29.
Lai JS, Eton DT: Clinically Meaningful Gaps. Rasch Measurement Transactions 2002,14(4):850.
30.
Andrich D, Lyne A, Sheridon B, Luo G: RUMM2020. Perth ; 2003.
31.
Marino RJ, Huang M, Knight P, Herbison GJ, Ditunno JFJ, Segal M: Assessing selfcare status in quadriplegia: comparison of the quadriplegia index of function (QIF) and the functional independence measure (FIM). Paraplegia 1993,31(4):225–233.PubMedCrossRef
32.
Wright BD, Linacre JM, Smith RM, Heinemann AW, Granger CV: FIM measurement properties and Rasch model details [letter; comment]. Scand J Rehabil Med 1997,29(4):267–272.PubMed
33.
Catz A, Itzkovich M, Agranov E, Ring H, Tamir A: SCIM--spinal cord independence measure: a new disability scale for patients with spinal cord lesions. Spinal Cord 1997,35(12):850–856. 10.1038/sj.sc.3100504PubMedCrossRef
34.
Nilsson AL, Sunnerhagen KS, Grimby G: Scoring alternatives for FIM in neurological disorders applying Rasch analysis. Acta Neurol Scand 2005,111(4):264–273. 10.1111/j.1600-0404.2005.00404.xPubMedCrossRef
35.
Grimby G, Andren E, Holmgren E, Wright B, Linacre JM, Sundh V: Structure of a combination of Functional Independence Measure and Instrumental Activity Measure items in community-living persons: a study of individuals with cerebral palsy and spina bifida. Arch Phys Med Rehabil 1996,77(11):1109–1114. 10.1016/S0003-9993(96)90131-8PubMedCrossRef
36.
Claesson L, Svensson E: Measures of order consistency between paired ordinal data: application to the Functional Independence Measure and Sunnaas index of ADL. J Rehabil Med 2001,33(3):137–144. 10.1080/165019701750166014PubMedCrossRef
37.
Heinemann AW, Semik P, Bode RK: Redusing step disorder in multidisciplinary FIM ratings.: 2001; Amsterdam, The Netherlands.. Monduzzi Editore S.p.A Bolonga, Italy.; 2001.
38.
Heinemann AW, Linacre JM, Wright BD, Hamilton BB, Granger C: Relationships between impairment and physical disability as measured by the functional independence measure. Arch Phys Med Rehabil 1993,74(6):566–573. 10.1016/0003-9993(93)90153-2PubMedCrossRef
39.
Kucukdeveci AA, Yavuzer G, Elhan AH, Sonel B, Tennant A: Adaptation of the Functional Independence Measure for use in Turkey. Clin Rehabil 2001,15(3):311–319. 10.1191/026921501676877265PubMedCrossRef
40.
Bode RK, Cella D, Lai JS, Heinemann AW: Developing an initial physical function item bank from existing sources. J Appl Meas 2003,4(2):124–136.PubMed
41.
Bode RK, Lai JS, Cella D, Heinemann AW: Issues in the development of an item bank. Arch Phys Med Rehabil 2003,84(4 Suppl 2):S52–60. 10.1053/apmr.2003.50247PubMedCrossRef
Metadata
Title
Cross-diagnostic validity in a generic instrument: an example from the Functional Independence Measure in Scandinavia
Authors
Å Lundgren-Nilsson
A Tennant
G Grimby
KS Sunnerhagen
Publication date
01-12-2006
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2006
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/1477-7525-4-55

Other articles of this Issue 1/2006

Health and Quality of Life Outcomes 1/2006 Go to the issue

Research

Pain in cancer. An outcome research project to evaluate the epidemiology, the quality and the effects of pain treatment in cancer patients

Research

Prevalence of visual impairment in relation to the number of ophthalmologists in a given area: a nationwide approach

Research

Health related quality of life trajectories and predictors following coronary artery bypass surgery

Research

Sexual activity and perceived health among Finnish middle-aged women

Research

The impact of iron overload and its treatment on quality of life: results from a literature review

Review

Transdermal opioids for cancer pain