Simplified Post-stroke Functioning Assessment Based on ICF via Dichotomous Mokken Scale Analysis and Rasch Modeling

Abstract

PurposeThis study aims to accomplish two tasks for International Classification of Functioning, Disability and Health (ICF) application among persons with stroke: (1) to make an ICF tool for measuring personal abilities with simplified assessment operations; (2) to quantitatively evaluate ICF categories for being functioning rather than being disabled.MethodsA total of 130 inpatients with stroke via convenience sampling were evaluated by the extended comprehensive ICF core set for stroke, modified Rankin scale, and modified Barthel index (MBI). This study investigated the responses to 118 stroke-related ICF items (59 items in b and d domains individually) using Mokken scale analysis followed with Rasch modeling.ResultsA Mokken scale with 47 items was extracted from the binary data (1 as no-impairment or mild-impairment and 0 as moderate to complete impairment). A Rasch model with 45 items was derived from the Mokken scale. The conversion chart was available involving the original ordinal scores to Rasch-transformed scores from 0 to 100 (interval scale). Total scores exhibited a high correlation with the personal abilities estimated by the Rasch model. The personal ability also demonstrated a significantly strong correlation with the score of the MBI. Thus, the 45 ICF items were suggested to rate potential functional ability as a single measurement.ConclusionBased on simple “functioning or disabled” judgment tasks, ICF assessment can be simplified to a questionnaire with answering “yes-or-no” questions for each category. Functioning level for each person and difficulty of being functioning for each category can be estimated by the Rasch model of this questionnaire.

Activity and participation in haemophiliacs: Item response modelling based on international classification of functioning, disability and health

“…On the other hand, although the short version of the Haemo‐QoL Index can serve as a screening tool, it cannot represent full contents of the original version. Neither of them can simultaneously fulfil the requirement of sufficiency and efficiency in clinical outcome measures 9 . Separately, although HAL evaluates activities and participation, and records functional changes over time, 24 it might not offer an opportunity for comparison among different scales.…”

“…Neither of them can simultaneously fulfil the requirement of sufficiency and efficiency in clinical outcome measures. 9 Separately, although HAL evaluates activities and participation, and records functional changes over time, 24 Item difficulties are elaborated on the right side of the map. The most difficult items for participants to achieve are located at the top of the map, and the easiest items for participants to achieve are at the bottom.…”

“…The Rasch model, one of the parametric models based on item response theory (IRT), has been widely used in the field of ICF research to overcome the limitation that assumes that each functional item is equally difficult. An example would be dichotomous post‐stroke functional assessment, 9 a clinical nursing assessment tool for spinal cord injury, 10 activity and participation evaluation for individuals with chronic obstructive pulmonary disease, 11 and functional recovery among patients with various health conditions 12 . Unfortunately, there was no currently available haemophilia‐related ICF scale based on the IRT model.…”

Mandarin Stroke Social Network Scale and Item Response Theory

“…In our previous work, we developed the ICF-IRT model with great reliability and validity among 130 stroke survivors, which can manifest personal functional competence and ICF item difficulty. We also revealed the process to build the ICF-IRT model in detail (Feng et al, 2022).…”

“…In recent years, non-parametric IRT models based on the Mokken scale analysis (MSA) have begun to attract attention in the medical areas (Stochl et al, 2012;Thompson et al, 2014;Vaughan and Grace, 2018;Zhang and Li, 2020). Rather than following strict rules for the parametric IRT, MSA can offer preparation processes of data shaping and hypothesis testing before parametric IRT modeling (Lee et al, 2016;Feng et al, 2022).…”