The Activities of Daily Vision Scale for Cataract Surgery Outcomes: Re-evaluating Validity with Rasch Analysis (original) (raw)
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Ophthalmic Epidemiology, 2008
To assess and re-engineer the Vision Core Measure 1 (VCM1) questionnaire in low vision (LV) and cataract participants using Rasch analysis. Methods: 295 participants drawn from a low vision clinic and 181 from a cataract surgery waiting list completed the 10-item VCM1. Unidimensionality, item fit to the model, response category performance, differential item functioning (DIF) and targeting of items to patients were assessed. Category collapsing and item removal were considered to improve the questionnaire. Results: The initial fit of the VCM1 (combined populations) to the Rasch model showed lack of fit (χ2 = 83.3, df = 50, p = 0.002). There was evidence of DIF between the two populations which could not be resolved. Consequently, each population was assessed separately. Irrespective of the population, disordering of response category thresholds was evident. However, collapsing categories produced ordered thresholds and resulted in fit to the Rasch model for the LV (Total χ2 = 41.6, df = 30; p = 0.08) and cataract population (Total χ2 = 17.9, df = 20, p = 0.59). Overall, the VCM1 behaved as a unidimensional scale for each population and no item showed evidence of DIF. Item targeting to patients was however sub-optimal particularly for the cataract population. Conclusion: The VCM1 questionnaire could be improved by shortening the response scale, although different response categories are required for cataract and LV populations. Calibration of items also differed across populations. While the VCM1 performs well within the Rasch model, in line with its initial purpose, it requires the addition of items to satisfactorily target low vision and cataract populations.
Rasch Analysis of the Quality of Life and Vision Function Questionnaire
Optometry and Vision Science, 2009
Purpose. The Quality of life and Vision Function Questionnaire (QOL-VFQ) was developed using classical test theory to assess outcomes of cataract surgery. The aim of this study was to examine the psychometric properties of this questionnaire using Rasch analysis in a cataract population. Methods. The 17-item QOL-VFQ was self-administered to 389 patients waiting to undergo cataract surgery. The QOL-VFQ and its five subscales were assessed for fit to the Rasch model. Rasch analysis was used to estimate interval level measures of "visual ability" from ordinal scores for the QOL-VFQ and its five subscales. Unidimensionality, item fit, response category performance, and targeting of items to patients were assessed. Results. The QOL-VFQ and its five subscales showed ordered category thresholds. Despite removal of two misfitting items the person separation reliability was high and the QOL-VFQ could distinguish among three strata of patient ability. However, there was suboptimal targeting of patient ability to item difficulty as most of the patients had higher levels of visual functioning. None of the subscales demonstrated acceptable psychometric properties. Conclusions. These results support the good overall functioning of the QOL-VFQ in patients with cataract. However, adding more items, that suit the more able patients including those who are awaiting cataract surgery in the fellow eye, will help improve the targeting. (Optom Vis Sci 2009;86:E836-E844)
Psychometric properties of visual functioning index using Rasch analysis
Acta Ophthalmologica, 2010
Purpose: The visual functioning index (VFI) was one of the first questionnaires developed using classical test theory to assess outcomes of cataract surgery. However, it was not Rasch-validated. The objective of this study was to examine the psychometric properties of the VFI using Rasch analysis in patients with cataract. Methods: The 11-item VFI was self-administered to 243 patients (mean age 73.9 years) drawn from a cataract surgery waiting list. We examined the response category thresholds, item fit statistics, differential item functioning and unidimensionality for the VFI and its three subscales. Results: Category thresholds were ordered. The person separation and reliability were low, indicating the poor discriminatory ability of the VFI. No items misfit but there was suboptimal targeting of item difficulty to patient ability. On the whole the items in the VFI were too easy for the sample. Only one item showed moderate differential item functioning. Conclusion: The VFI does not meet the stringent requirements of the Rasch model. However adding more items to suit the more able patients with cataract as well as those awaiting second-eye cataract surgery could optimize the VFI.
Investigative Ophthalmology & Visual Science, 2009
To determine whether the VF-11 is a valid scale to measure visual functioning in an Asian population with vision impairment. METHODS. Participants from the Singapore Malay Eye Study (SiMES) took part. Visual functioning was assessed by using the VF-11 (a modified version of VF-14 for an Asian population). Rasch analysis was performed on 618 participants with presenting visual acuity Ͻ 6/12 in the better eye. RESULTS. Disordered thresholds were initially evident, indicating that the categories were difficult to discriminate and required category collapsing (from 5 to 4) for nine items. The removal of two misfit items related to driving resulted in a fit of the VF-9 data to the Rasch model ( 2 ϭ 50.5, df ϭ 27, P ϭ 0.005). There were no more misfit items. The person separation reliability value was 0.82 which demonstrates that the VF-9 has sufficient ability to discriminate between at least two groups of participants with different levels of visual functioning. The VF-9 significantly differentiated patients stratified by visual acuity demonstrating adequate criterion validity. All items were free of differential item functioning, and there was no evidence of multidimensionality. Targeting of person ability and item difficulty was suboptimal, although this is inevitable in a population-based survey where most people would not be disabled. CONCLUSIONS. Although the Rasch-modified VF-9 scale achieved fit to the Rasch model, its suboptimal targeting suggests that the instrument does not have the range of items to assess the impact of vision impairment across the severity spectrum of vision loss in this population. (Invest Ophthalmol Vis Sci.
Rasch analysis of the Indian vision function questionnaire
British Journal of Ophthalmology, 2012
Aim To investigate the psychometric properties of the three scales (general functioning, psychosocial impact, visual symptoms) of the Indian vision function questionnaire (INDeVFQ) using the Rasch measurement model. Methods 236 visually impaired patients referred to vision rehabilitation centres were administered the 33item INDeVFQ. Rasch analysis was used to investigate the scales for the following properties: precision by person separation (ie, discrimination between strata of patient ability, recommended minimum value 2.0), unidimensionality (ie, measurement of a single construct) and targeting (ie, matching of item difficulty to patient ability). Results Only the general functioning scale possessed adequate measurement precision (person separation 3.49). However, it lacked unidimensionality as some items did not contribute towards the measurement of a single construct indicating a secondary dimension. This comprised seven mobility items, which formed a separate valid subscale with good targeting (À0.57 logits). Deleting these items restored unidimensionality but a misfitting item required removal. Following this the 13 items fit and were visual functioning related. However, targeting was suboptimal (À1.13 logits). Conclusions The general functioning scale of the INDeVFQ consists of two separate unidimensional constructs: visual functioning and mobility. Both these Rasch scaled versions with good psychometric properties are effective tools for the assessment of visually impaired patients in India.