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Cross-cultural validity of functional independence measure items in stroke: a study using Rasch analysis.

Journal article
Authors Åsa Lundgren Nilsson
Gunnar Grimby
Haim Ring
Luigi Tesio
Gemma Lawton
Anita Slade
Massimo Penta
Maria Tripolski
Fin Biering-Sørensen
Jane Carter
Crt Marincek
Suzanne Phillips
Anna Simone
Alan Tennant
Published in Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine
Volume 37
Issue 1
Pages 23-31
ISSN 1650-1977
Publication year 2005
Published at Institute of Clinical Neurosciences
Pages 23-31
Language en
Keywords Activities of Daily Living, Aged, Cerebrovascular Accident, psychology, rehabilitation, Cognition, Cross-Cultural Comparison, Cultural Characteristics, Europe, Female, Humans, Male, Middle Aged
Subject categories Medical and Health Sciences


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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