Abstract
BackgroundIn the analysis of clinical trial endpoints, calibration of patient-reported outcomes (PRO) instruments ensures that resulting “scores” represent the same quantity of the measured concept between applications. Rasch measurement theory (RMT) is a psychometric approach that guarantees algebraic separation of person and item parameter estimates, allowing formal calibration of PRO instruments. In the RMT framework, calibration is performed using the item parameter estimates obtained from a previous “calibration” study. But if calibration is based on poorly estimated item parameters (e.g., because the sample size of the calibration sample was low), this may hamper the ability to detect a treatment effect, and direct estimation of item parameters from the trial data (non-calibration) may then be preferred. The objective of this simulation study was to assess the impact of calibration on the comparison of PRO results between treatment groups, using different analysis methods.MethodsPRO results were simulated following a polytomous Rasch model, for a calibration and a trial sample. Scenarios included varying sample sizes, with instrument of varying number of items and modalities, and varying item parameters distributions. Different treatment effect sizes and distributions of the two patient samples were also explored. Comparison of treatment groups was performed using different methods based on a random effect Rasch model. Calibrated and non-calibrated approaches were compared based on type-I error, power, bias, and variance of the estimates for the difference between groups.Results There was no impact of the calibration approach on type-I error, power, bias, and dispersion of the estimates. Among other findings, mistargeting between the PRO instrument and patients from the trial sample (regarding the level of measured concept) resulted in a lower power and higher position bias than appropriate targeting. ConclusionsCalibration of PROs in clinical trials does not compromise the ability to accurately assess a treatment effect and is essential to properly interpret PRO results. Given its important added value, calibration should thus always be performed when a PRO instrument is used as an endpoint in a clinical trial, in the RMT framework.
Evaluation of the Impact of Calibration of Patient-Reported Outcomes Measures on Clinical Trial Results: A Simulation Study based on Rasch Measurement Theory