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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.

Journal article
Authors Alan Tennant
Massimo Penta
Luigi Tesio
Gunnar Grimby
Jean-Louis Thonnard
Anita Slade
Gemma Lawton
Anna Simone
Jane Carter
Åsa Lundgren Nilsson
Maria Tripolski
Haim Ring
Fin Biering-Sørensen
Crt Marincek
Helena Burger
Suzanne Phillips
Published in Medical care
Volume 42
Issue 1 Suppl
Pages I37-48
ISSN 0025-7079
Publication year 2004
Published at Institute of Clinical Neurosciences
Pages I37-48
Language en
Keywords Activities of Daily Living, classification, psychology, Adaptation, Psychological, Analysis of Variance, Cerebrovascular Accident, psychology, rehabilitation, Cross-Cultural Comparison, Disability Evaluation, Europe, Female, Humans, Male, Models, Theoretical, Outcome Assessment (Health Care), methods, statistics & numerical data, Principal Component Analysis, Probability, Psychometrics, statistics & numerical data, Questionnaires, standards, Recovery of Function, physiology, Reproducibility of Results, Self Efficacy, Sensitivity and Specificity, Sickness Impact Profile
Subject categories Medical and Health Sciences


INTRODUCTION: In Europe it is common for outcome measures to be translated for use in other languages. This adaptation may be complicated by culturally specific approaches to certain tasks; for example, bathing. In this context the issue of cross-cultural validity becomes paramount. OBJECTIVE: To facilitate the pooling of data in international studies, a project set out to evaluate the cross-cultural validity of impairment and activity limitation measures used in rehabilitation from the perspective of the Rasch measurement model. METHODS: Cross-cultural validity is assessed through an analysis of Differential Item Functioning (DIF) within the context of additive conjoint measurement expressed through the Rasch model. Data from patients undergoing rehabilitation for stroke was provided from 62 centers across Europe. Two commonly used outcome measures, the Mini-Mental State Examination (MMSE) and the Functional Independence Measure (FIM) motor scale are used to illustrate the approach. RESULTS: Pooled data from 3 countries for the MMSE were shown to fit the Rasch model with only 1 item displaying DIF by country. In contrast, many items from the FIM expressed DIF and misfit to the model. Consequently they were allowed to be unique across countries, so resolving the lack of fit to the model. CONCLUSIONS: Where data are to be pooled for international studies, analysis of DIF by culture is essential. Where DIF is observed, adjustments can be made to allow for cultural differences in outcome measurement.

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