Progress in Medical Rehabilitation: Issues in Measurement

"Progress in Medical Rehabilitation: Issues in Measurement" was the title of a conference sponsored by the Buffalo General Hospital Department of Rehabilitation Medicine, and the School of Medicine and Biomedical Sciences, State University of New York at Buffalo (June 18-19, 1992). The tone of the conference was one of confidence in the potential of Rasch measurement models for making sense of functional assessment data. As Julia Costich said, "This conference will be seen in the future as a watershed event in the history of functional assessment because of the clear advances made in understanding of the data."

Benjamin D. Wright was a guest of honor and spoke on "Turning Scores into Measures: Reasons for Rasch Analysis." Carl Granger, the host and M.C., handed the microphone over to Ben Wright for his comments after every paper, so the effect was one of being at a two day Rasch seminar on the analysis and interpretation of functional assessment scales. Topics discussed included Rasch measurement basics, self-scoring forms for functional assessment, three kinds of functional status measures for pediatric applications, rater calibration, fit analysis, and functional assessment instrument validities.

Papers were presented by Carl Granger, Allen Heinemann, Stephen Haley, Michael Linacre, Michael Msall, Burton Silverstein, Suzann Campbell and Beth Osten, Judith Laughlin, Margaret Stineman, Mark Johnston, Robert Keith, Kenneth Ottenbacher, Julia Costich, James Green, J.E. (Ben) Marosszeky, and William Fisher for Anne Fisher. Gayle Whiteneck, who has published an article on the quantification of handicap using Rasch analysis, was a member of the audience.

A key topic that recurred in several presentations concerned the high correlation (.93) between two different instruments' Rasch item difficulty estimates; each instrument is intended to measure rehabilitation patients' motor skills (ambulation, moving from sitting to standing, etc), and each has items that address roughly the same areas of activity as items on the other instrument. The high correlation suggests that the two instruments are measuring the same construct, even though the ratings from which the different instruments' item calibrations were made were supplied by hundreds of therapists rating thousands of patients in dozens of facilities. The high correlation suggests that each of these two instruments is a form of one larger instrument.

Can we now verify that two or more instruments conceptualized to measure the same construct actually do so? Could new instruments, with characteristics identical to these two instruments, be constructed by selecting items from a bank of similar motor skills items? Would scaling all instruments of a similar type together arrive at a shared unit of measurement? Will such measures provide a means to evaluate and compare patient progress under alternative treatments? These are exciting times for the evaluation of physical medicine and rehabilitation.



Progess in Medical Rehabilitation, W Fisher Jr. … Rasch Measurement Transactions, 1992, 6:2 p. 214




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