Validity of a Diagnostic Scale for Acupuncture: Application of the Item Response Theory to the Five Viscera Score

Abstract

In acupuncture therapy, diagnosis, acupoints, and stimulation for patients with the same illness are often inconsistent among between Traditional Chinese Medicine (TCM) practitioners. This is in part due to the paucity of evidence-based diagnostic methods in TCM. To solve this problem, establishment of validated diagnostic tool is inevitable. We first applied the Item Response Theory (IRT) model to the Five Viscera Score (FVS) to test its validity by evaluating the ability of the questionnaire items to identify an individual's latent traits. Next, the health-related QOL scale (SF-36), a suitable instrument for evaluating acupuncture therapy, was administered to evaluate whether the FVS can be used to make a health-related diagnosis. All 20 items of the FVS had adequate item discrimination, and 13 items had high item discrimination power. Measurement accuracy was suited for application in a range of individuals, from healthy to symptomatic. When the FVS and SF-36 were administered to other subjects, a part of which overlap with the first subjects, we found an association between the two scales, and the same findings were obtained when symptomatic and asymptomatic subjects were compared regardless of age and sex. In conclusion, the FVS may be effective in clinical diagnosis.

Development of a Diagnostic Questionnaire for Damp Phlegm Pattern and Blood Stasis Pattern in Coronary Heart Disease Patients (CHD-DPBSPQ)

“…To develop the CHD-DPBSP diagnostic questionnaire, we used standard procedures for developing and validating the CHD-DPBSPQ [22][23][24][25][26][27][28][29]. e procedures included the following steps: construct definition, item generation, a pilot study, and a validation study.…”

“…Previous instruments for the assessment of CHD-DPBSP have not been widely adopted; our group formulated and validated TCM outcomes on the basis of standard development and validation procedures [22,28,40]. e US FDA and the WHOQOL group proposed the establishment of a conceptual framework for questionnaires [23,26]. According to TCM theories, the framework for DPBSP should be classified into damp phlegm and blood stasis patterns [10,11].…”

Influence of Biomedical Factors on the Five Viscera Score (FVS) on Middle-Aged and Elderly Individuals: Application of Structural Equation Modeling

“…These symptoms were selected through an explanatory factor analysis and considered to be affected by the viscera as latent factors. Naming of each factor was determined based on many TCM practitioners' opinion [ 10 , 14 , 18 ]. In a previous study, we utilized FVS that contained items that were difficult to answer (high item difficulty) [ 14 ].…”

“…Naming of each factor was determined based on many TCM practitioners' opinion [ 10 , 14 , 18 ]. In a previous study, we utilized FVS that contained items that were difficult to answer (high item difficulty) [ 14 ]. We modified this to be more suitable for clinical studies and the general public to reduce the burden on the respondent.…”

“…In general, using both classical test theory (CTT), such as Cronbach's alpha, and item response theory (IRT), which can remove the effects from the original population that developed the scale, increases the validity of the developed scale [ 12 , 13 ]. We therefore tested FVS with both CTT and IRT and have demonstrated its effectiveness [ 9 , 10 , 14 ]. However, common limitations among these studies were that they included very few women in the study population and did not assess middle-aged and elderly individuals.…”