Rasch in Medicine

Question: Do you have any information on the Rasch Model being used to examine the quality of medical diagnostic tests?
Daniel Cipriani

Answer: This area is rich with potential.

The first and commonest area of focus uses a performance assessment- or survey-based measure of a specific problem area as a diagnostic indicator (i.e., if you have a high measure, you have the problem); this approach is used by Tesio, et al. (1999), Teresi (1994), Ryser, et al. (1999), Penta, et al. (1998), Massof (1998), Malec, et al. (2000), Lai, et al. (1996), Hawley, et al. (1999), Cialdella, et al. (1992), Bode, et al. (2000), and others.

A second area of focus includes clinical process and outcome data, such as laboratory blood chemistry results, along with or instead of functional assessment or health status survey data; this approach is used by Fisher, et al. (2002), Fisher & Johnson (2000), and Wright, et al. (2000).

The third area of focus takes advantage of systematic variation in item difficulty orders in order to make diagnostically-relevant distinctions among patients. This area holds the fascinating potential of supporting computer-based alerts of areas in need of attention; this approach is used by Granger and Linn (2000), Granger and Wright (1993), and Linacre (1997).

William P. Fisher, Jr.


Answer: Another area is second language communication in health care settings. Work has been done on testing the clinical communicative skills of foreign medical graduates in Australia. The test involved, the Occupational English Test, and its validation using Rasch measurement is discussed in detail in my book "Measuring Second Language Performance," London and New York: Addison-Wesley Longman, 1996.

Tim McNamara, University of Melbourne


Bode, R., Heinemann, A., & Semik, P. (2000, Feb). Measurement properties of the Galveston Orientation and Amnesia Test (GOAT) and improvement patterns during inpatient rehabilitation. Journal of Head Trauma Rehabilitation, 15(1), 637-55.

Cialdella, P., Guillaud-Bataille, J. M., Gausset, M., Terra, J., Gerin, P., Palliard, E., & Jouishomme, J. (1992, Sep-Oct). [Study of the uni-dimensionality of the Yesavage-Brinck geriatric depression scale. Comparison between classical methods and Rasch's model]. [French]. Encephale, 18(5), 537-44.

Fisher, W. P., Jr., Bernstein, L. H., Qamar, A., Babb, J., Rypka, E. W., & Yasick, D. (2002, February). At the bedside: Measuring patient outcomes [diagnosing AMI from blood work]. Advance for Administrators of the Laboratory, 11(2), 8, 10.

Fisher, W. P., Jr., & Johnson, J. (2000, April). Scaling the Diabetes Quality Improvement Project indicators. Presented at the Sixth AHRQ/CDC Building Bridges Conference. Atlanta, Georgia.

Granger, C., & Linn, R. (2000). Biologic patterns of disability [using functional assessment scales to diagnose disability by means of DIF]. Journal of Outcome Measurement, 4(2), 595-615.

Granger, C. V., & Wright, B. D. (1993). Looking ahead to the use of

functional assessment in ambulatory physiatric and primary care [using functional assessment scales to diagnose disability by means of DIF] (C. V. Granger, & G. E. Gresham eds.) [Special issue]. Physical Medicine and Rehabilitation Clinics of North America: New Developments in Functional Assessment, 4(3), 595-605.

Hawley, C., Taylor, R., Hellawell, D., & Pentland, B. (1999, Dec). Use of the functional assessment measure (FIM+FAM) in head injury rehabilitation: A psychometric analysis. Journal of Neurology, Neurosurgery & Psychiatry, 67(6), 749-54.

Kilgore, K. M., Fisher, W. P., Jr., Harvey, R. F., & Silverstein, B. (1993). Diagnosis-based differences in Rasch calibrations of functional assessment scales (abstract). Archives of Physical Medicine and Rehabilitation, 74, 1254.

Lai, J., Fisher, A., Magalhaes, L., & Bundy, A. C. (1996). Construct validity of the sensory integration and praxis tests. Occupational Therapy Journal of Research, 16(2), 75-97.

Linacre, J. M. (1997). Instantaneous measurement and diagnosis. Physical Medicine and Rehabilitation State of the Art Reviews, 11(2), 315-324.

Malec, J., Moessner, A., Kragness, M., & Lezak, M. (2000, Feb). Refining a measure of brain injury sequelae to predict postacute rehabilitation outcome: Rating scale analysis of the Mayo-Portland Adaptability Inventory. Journal of Head Trauma Rehabilitation, 15(1), 670-82.

Massof, R. (1998, May). A systems model for low vision rehabilitation. II. Measurement of vision disabilities. Optometry & Vision Science, 75(5), 349-73.

Penta, M., Thonnard, J., & Tesio, L. (1998, Sep). ABILHAND: A Rasch-built measure of manual ability. Archives of Physical Medicine & Rehabilitation, 79(9), 1038-42.

Ryser, L., Wright, B., Aeschlimann, A., Mariacher-Gehler, S., & Stucki, G. (1999, Oct). A new look at the Western Ontario and McMaster Universities Osteoarthritis Index using Rasch analysis. Arthritis Care & Research, 12(5), 331-5.

Teresi, J. (1994). Overview of methodological issues in the study of chronic care populations. [Review] [80 refs]. Alzheimer Disease & Associated Disorders, 8(Suppl 1), S247-73.

Tesio, L., Alpini, D., Cesarani, A., & Perucca, L. (1999, May- Jun). Short form of the Dizziness Handicap Inventory: Construction and validation through Rasch analysis. American Journal of Physical Medicine & Rehabilitation, 78(3), 233-41.

Wright, B. D., Perkins, K., & Dorsey. (2000). Multiple regression via measurement [diagnosing gout]. Rasch Measurement Transactions, 14(1), 729-30 [www.rasch.org/rmt/rmt141a.htm].

Rasch in Medicine. Fisher W.P. Jr., McNamara T. … 15:4 p. 852-853


Rasch in Medicine Fisher W.P. Jr., McNamara T. … Rasch Measurement Transactions, 2002, 15:4 p. 852-853

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Rasch Publications
Rasch Measurement Transactions (free, online) Rasch Measurement research papers (free, online) Probabilistic Models for Some Intelligence and Attainment Tests, Georg Rasch Applying the Rasch Model 3rd. Ed., Bond & Fox Best Test Design, Wright & Stone
Rating Scale Analysis, Wright & Masters Introduction to Rasch Measurement, E. Smith & R. Smith Introduction to Many-Facet Rasch Measurement, Thomas Eckes Invariant Measurement: Using Rasch Models in the Social, Behavioral, and Health Sciences, George Engelhard, Jr. Statistical Analyses for Language Testers, Rita Green
Rasch Models: Foundations, Recent Developments, and Applications, Fischer & Molenaar Journal of Applied Measurement Rasch models for measurement, David Andrich Constructing Measures, Mark Wilson Rasch Analysis in the Human Sciences, Boone, Stave, Yale
in Spanish: Análisis de Rasch para todos, Agustín Tristán Mediciones, Posicionamientos y Diagnósticos Competitivos, Juan Ramón Oreja Rodríguez

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