Development of a New Scale to Assess Physical Performance in a Standing Position and During Ambulation Related to the Activities of Daily Living of Stroke Patients: Scale Development Based on the Rasch Model

Background: The BETA nursing measure has been introduced as a tool to routinely measure and monitor the outcomes of patients' activities of daily living in a restorative nursing care context.Objectives: To investigate the BETA's construct validity using the Rasch model with specific reference to the BETA's potential to be used as an interval scale providing metric or interval data.Method: A quantitative analytical design was followed using Rasch analyses whereby BETA raw data was collected from patients (n = 4235) receiving nursing care in 28 South African sub-acute and non-acute nursing facilities. The data was prepared for Rasch analyses and imported into WINSTEP® Software version 3.70.1.1 (2010). Final results were shown by means of figures and graphs.Results: A successful outcome was achieved by dividing the BETA into four subscales. In this process one of the original BETA items was omitted and seven other items required collapsing of their categories before the four subscales achieved a satisfactory fit to the Rasch model.Conclusion: The four BETA subscales achieved “very well” to “excellent” levels of fit to the Rasch model. This finding thus creates an opportunity to convert the BETA's Likert qualities into an interval measure to calculate change in patients' activities of daily living metric allyas a direct result of effective restorative nursing.

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Measuring global functioning in older adults with cognitive impairments using the Rasch model

BMC Geriatrics ◽

10.1186/s12877-020-01886-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Rocco Palumbo ◽

Alberto Di Domenico ◽

Federica Piras ◽

Salvatore Bazzano ◽

Mario Zerilli ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Activities Of Daily Living ◽

Rasch Model ◽

Daily Living ◽

Cognitive Impairments ◽

Clinical Intervention ◽

Global Functioning ◽

Functional Measures ◽

The Rasch Model

Abstract Background Cognitive and functional measures are often measured and interpreted separately during the clinical evaluation of patients with cognitive impairment. This can sometimes lead to a challenging interpretation when measures do not show concordance, especially after a clinical intervention. In this study, the development and evaluation of a new approach, using the Rasch model, that combines cognitive and functional measures in one single and more powerful measure (compared to stand-alone tests) to assess global functioning in older adults with cognitive impairment (including dementia) was presented. Methods Clinical data from 265 older adults’ subjects diagnosed with mild cognitive impairment, or dementia, included: The Mini-mental state examination (MMSE), the Esame Neuropsicologico Breve (ENB) – a neuropsychological battery used in Italy–, the Activities of Daily Living (ADL), and the Instrumental Activities of Daily Living (IADL) questionnaires. Results Patients with severe cognitive impairment showed lower global functioning score compared to patients with moderate impairment. Receiver Operating Characteristic (ROC) curve analyses were performed to determine sensitivity and specificity of the global functioning score resulting from the combined measure. Results showed that the global functioning score discriminates better between patients with severe and moderate cognitive impairment compared to the ENB, ADL, and IADL when considered separately. Conclusions The Rasch model was able to combine cognitive and functional measures into a single score (global functioning score). All together, these results suggest that the diverse cognitive and functional measures can be considered part of one single dimension (global functioning) and that this dimension can be measured as a single construct and score. This study offers an alternative perspective for future development of instruments that would help clinicians in measuring global functioning in older adults’ patients at different stages of cognitive impairments and different baseline level of performance.

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