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Aim This study aimed to explore the potential of an inclusive and fully integrated measurement system for the Activities component of the International Classification of Functioning, Disability and Health (ICF), incorporating four classical scales, including the Health Assessment Questionnaire (HAQ), and a Computerized Adaptive Testing (CAT). Methods Three hundred patients with rheumatoid arthritis (RA) answered relevant questions from four questionnaires. Rasch analysis was performed to create an item bank using this item pool. A further 100 RA patients were recruited for a CAT application. Both real and simulated CATs were applied and the agreement between these CAT-based scores and 'paper-pencil' scores was evaluated with intraclass correlation coefficient (ICC). Anchoring strategies were used to obtain a direct translation from the item bank common metric to the HAQ score. Results Mean age of 300 patients was 52.3 ± 11.7 years; disease duration was 11.3 ± 8.0 years; 74.7% were women. After testing for the assumptions of Rasch analysis, a 28-item Activities item bank was created. The agreement between CAT-based scores and paper-pencil scores were high (ICC = 0.993). Using those HAQ items in the item bank as anchoring items, another Rasch analysis was performed with HAQ-8 scores as separate items together with anchoring items. Finally a conversion table of the item bank common metric to the HAQ scores was created. Conclusion A fully integrated and inclusive health assessment system, illustrating the Activities component of the ICF, was built to assess RA patients. Raw score to metric conversions and vice versa were available, giving access to the metric by a simple look-up table. [ABSTRACT FROM AUTHOR]

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Objectives: In this study, we investigated the psychometric properties of the International Classification of Functioning, Disability and Health (ICF) core set for low back pain (LBP). Patients and methods: One-hundred outpatients with LBP (73 females, 27 males; mean age 55.3 years; range 24 to 84 years) were assessed by the ICF core set for LBP. The patients also completed the Roland-Morris disability questionnaire (RMDQ) and Short Form-36 (SF-36) questionnaire. The internal construct validity of the ICF core set for LBP was assessed by Rasch analysis and external construct validity by correlations with the RMDQ and SF-36 Health Survey version 1.0. Reliability was tested by internal consistency and person separation index. Results: After rescoring the disordered response categories and deletion of some items, "body functions and body structures" and "activities and participation" item sets satistifed Rasch model expectations with a mean item fit of 0.005 (SD 0.619) and -0.006 (SD 0.730), and person fit of -0.165 (SD 0.561) and -0.084 (SD 0.806) respectively. Both item sets were unidimensional and showed no differential item functioning. Their reliabilities were good with Cronbach's alpha coefficient and person separation index levels above 0.77. Although the mean functionality level of the patients was lower than the mean difficulty level of the items, the distribution of the difficulty level of the items overlapped with the distribution of the functionality level of the patients for both item sets. The presence of the expected level of correlations between both item sets and RMDQ and SF-36 has confirmed the external construct validity. "Environmental factors" did not meet the assumptions of the Rasch analysis. Conclusion: After some modifications, a 15-item "body functions and body structures" set and a 21-item "activities and participation" set from the ICF comprehensive core set were found to be reliable and valid to assess functioning in patients with LBP. [ABSTRACT FROM AUTHOR]

Objective: To investigate the psychometric properties of the Health Assessment Questionnaire Disability Index (HAQ-DI) and the modified HAQ (MHAQ) in patients with knee osteoarthritis (OA). Materials and Methods: The internal construct validity of the HAQ-DI and MHAQ were assessed by Rasch analysis and external construct validity by associations with the Western Ontario and McMaster Universities Index of Osteoarthritis Index (WOMAC), the World Health Organization Disability Assessment Schedule (WHODAS-II) and the Nottingham Health Profile (NHP). Reliability was tested by internal consistency and person separation index. Results: Two hundred and fifteen outpatients with knee OA (mean age±standard deviation (SD) 57.7±10.9 years; 81% female) filled in the assessment scales including HAQ-DI, WOMAC, WHODAS-II and the NHP. MHAQ was not administered as a separate measure but scored by using the HAQ-DI forms. Both the HAQ-DI and the MHAQ data satisfied Rasch model expectations with a mean item fit of 0.096 (SD 1.186) and -0.312 (SD 1.063), and person fit of 0.307 (SD 0.895) and -0.329 (SD 0.879), respectively. Both scales were unidimensional and showed no differential item functioning. The reliabilities of both scales were good with high Cronbach's alpha and PSI levels above 0.85. However neither of them was particularly well targeted to the current population who displayed a level of disability much below the average difficulty level of the scales. External construct validity was confirmed by expected correlations with WOMAC, WHODAS-II and NHP. Although the distribution of both scales was right skewed, the floor effect was more prominent in MHAQ. Conclusion: Both the HAQ-DI and MHAQ are found to be reliable and valid to assess physical disability in patients with knee OA. However, the possible floor effect in this diagnostic group should be kept in mind. [ABSTRACT FROM AUTHOR]