A new European grant under the BIOMED2 R&D program will seek to standardize outcome measurement in Physical Medicine & Rehabilitation across 14 countries, including the UK, Denmark, Italy and Israel. This three year Concerted Action project will see some 51 rehabilitation facilities collecting data from a wide range of standardized instruments, both old and new, covering a broad spectrum of impairments, disabilities, handicaps and quality of life. Five regional centers will analyze the resulting data with the Rasch model. If the data are adequate (fit, DIF, local independence and stability over time) cross-cultural validity will be assessed at the Rheumatology & Rehabilitation Research Unit (RRRU) at the University of Leeds.
The full objectives of the study are:
1. To identify the outcome measures used in Rehabilitation across Europe.
2. To evaluate, using Rasch measurement, the cross-diagnostic and cross-cultural validity of selected outcome measures.
3. To co-calibrate different measures assessing the same construct (within country and diagnosis).
4. To construct an item bank for each outcome construct used in Rehabilitation.
The study commences on April 1st, 1998, and the first year is given over to a survey of 500+ rehabilitation facilities and the range of measures they use. Following a review meeting, a selection of measures will be chosen for inclusion in the full study. Once the results are available, a special invitational conference will be held to make recommendations about instruments (or sets of items from an item bank) that can be used local and international clinical trials. The advantage of co-calibration and item banking is that the identical instruments do not have to be used everyehwere. This is important where local language versions of particular instruments are not available.
Another large study involves the development of a Quality of Life (QoL) item bank for rheumatic disease, so that disease-specific measures can be linked through the item bank to produce comparable measures. This negates the use of less responsive generic measures, most of which measure impairment and disability (health status) rather than QoL.
Another study uses Rasch measurement and latent class analysis in continuing care assessment. When people are being considered for care in hospital, nursing home or residential care, can we make the decision about placement more objective? The project's aim is to help the multidisciplinary team in what can be a very difficult task.
In other work, instruments undergoing evaluation include measures of physical function (disability) in Juvenile Chronic Arthritis; a range of psycho-social measures used in association with a study of consultation for back pain, and a set of psycho-social measures for use following traumatic brain injury. A program of methodological investigation is also under way, including a comparison of different software and the impact of aspects such as missing data on different operational algorithms.
Rheumatology-Rehabilitation Research Unit
36 Clarendon Road, Leeds LS2 9NZ
Tennant A. (1998) Rasch-based Medical Research at University of Leeds, England. Rasch Measurement Transactions 11:4 p. 601.
Rasch-based Medical Research at University of Leeds, England. Tennant A. Rasch Measurement Transactions, 1998, 11:4 p. 601.
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