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STUDY DESIGN: Retrospective analysis of cross-sectional data. OBJECTIVE: To describe the development of a new self-report Neck Functional Status Questionnaire (NFSQ) and to assess its psychometric properties and practical application. The NFSQ was designed to assess functional status in patients with cervical (spine) disorders who seek outpatient therapy. BACKGROUND: Many patients seek outpatient therapy due to cervical disorders. Currently, no patient-reported outcome measures exist that capture the ability to perform functional activity in a manner that reflects the experience of this patient population. METHODS: Four hundred thirty-nine patients who were being treated for cervical disorders responded to a set of survey questions to assess activity-related functional outcomes associated with cervical disorders. Using item response theory, we assessed candidate items for unidimensionality and local independence, item fit, person separation, precision, targeting, and differential item functioning. We also compared discriminant validity of functional status measures estimated by the item response theory model (NFSQ fixed) and measures generated using a simulated computerized adaptive test (NFSQ computerized adaptive test). RESULTS: Based on expert opinion and subsequent processing and analyses, a final set of 28 items was used to develop the NFSQ. Unidimensionality and local independence were supported. The mean ± SD sample ability level of 57.6 ± 14.3 (scale range, 0-100) matched well with the mean item difficulty of the NFSQ of 51.3 ± 7.4. Differential item functioning was negligible for levels of age group, sex, and symptom acuity. The NFSQ computerized adaptive test measures were as precise as the NFSQ fixed measures. CONCLUSION: Study results supported the preliminary validity of the 28-item NFSQ for use in assessing patients with different levels of functional status related to their cervical disorders in outpatient rehabilitation settings. [ABSTRACT FROM AUTHOR]

Purpose: Measurement invariance is necessary for meaningful group comparisons. The purpose of this study was to test measurement invariance of three patient-reported measures of depressive symptoms between neurologic and community samples. Methods: The instruments tested included the center for epidemiologic studies depression scale (CESD-20), the patient health questionnaire-9 (PHQ-9), and the patient-reported outcome measurement information system depression short form (PROMIS-D-8). Responses from a community sample were compared to responses from samples with two neurologic conditions: multiple sclerosis and spinal cord injury. Multi-group confirmatory factor analysis was used to evaluate successive levels of measurement invariance: (a) configural invariance, i.e., equivalent item factor structure between groups; (b) metric invariance, i.e., equivalent unstandardized factor loadings between groups; and (c) scalar invariance, i.e., equivalent item intercepts between groups. Results: Results of this study supported metric invariance for the CESD-20, PHQ-9, and PROMIS-D-8 scores between the community sample and the samples with neurologic conditions. The most rigorous form of invariance (i.e., scalar) also holds for the CESD-20 and the PROMIS-D-8. Conclusions: The current study suggests that depressive symptoms as measured by three different outcome measures have the same meaning across clinical and community samples. Thus, the use of these measures for group comparisons is supported. [ABSTRACT FROM AUTHOR]

Purpose: To establish clinically relevant classifications of health outcome scores for four Neuro-QOL measures (lower extremity function, upper extremity function, fatigue, and sleep disturbance). Methods: We employed a modified educational standard-setting methodology to identify cut-scores for symptom severity. Clinical vignettes were developed to represent graduated levels of symptom severity. A clinician panel and a panel of persons with multiple sclerosis (PwMS) were recruited, and, in separate, 1-day meetings, the panelists identified adjacent vignettes they judged to represent the threshold between two levels of severity for a given domain (e.g., threshold between a vignette that indicated 'no problems' with sleep and the adjacent one that represented 'mild problems' with sleep). Working independently, each panel (PwMS and clinicians) reached consensus on its recommended thresholds for each of the four targeted measures. Cut-scores were defined as the mean location for each pair of threshold vignettes. Results: PwMS and clinician panels derived identical thresholds for severity levels of lower extremity function and sleep disturbance, but slightly different ones for upper extremity function and fatigue. In every case of divergence, PwMS set higher thresholds for more severe classifications of symptoms (by 0.5 SDs) than did clinicians. Conclusions: The modified bookmarking method is effective for defining thresholds for symptom severity based on self-reported outcome scores and consensus judgments. Derived cut-scores and severity levels provide an interpretative context for Neuro-QOL scores. Future studies should explore whether these findings can be replicated and evaluate the validity of the classifications compared to external criteria. [ABSTRACT FROM AUTHOR]

Background: Although the use of patient-reported outcome measures (PROs) has increased markedly, clinical interpretation of scores remains lacking. We developed a method to identify clinical severity thresholds for pain, fatigue, depression, and anxiety in people with cancer. Methods: Using available Patient-Reported Outcomes Measurement Information System (PROMIS) item bank response data collected on 840 cancer patients, symptom vignettes across a range of symptom severity were developed and placed on index cards. Cards represented symptom severity at five-point intervals differences on the T score metric [mean = 50; standard deviation (SD) = 10]. Symptom vignettes for each symptom were anchored on these standardized scores at 0.5 SD increments across the full range of severity. Clinical experts, blind to the PROMIS score associated with each vignette, rank-ordered the vignettes by severity, then arrived at consensus regarding which two vignettes were at the upper and lower boundaries of normal and mildly symptomatic for each symptom. The procedure was repeated to identify cut scores separating mildly from moderately symptomatic, and moderately from severely symptomatic scores. Clinician severity rankings were then compared to the T scores upon which the vignettes were based. Results: For each of the targeted PROs, the severity rankings reached by clinician consensus perfectly matched the numerical rankings of their associated T scores. Across all symptoms, the thresholds (cut scores) identified to differentiate normal from mildly symptomatic were near a T score of 50. Cut scores differentiating mildly from moderately symptomatic were at or near 60, and those separating moderately from severely symptomatic were at or near 70. Conclusions: The study results provide empirically generated PROMIS T score thresholds that differentiate levels of symptom severity for pain interference, fatigue, anxiety, and depression. The convergence of clinical judgment with self-reported patient severity scores supports the validity of this methodology to derive clinically relevant symptom severity levels for PROMIS symptom measures in other settings. [ABSTRACT FROM AUTHOR]

• An improved and comprehensive technique for measuring/assessing self-reported physical function is needed in MS. • We have developed a new PROMIS short form for assessing physical function in MS. • The new short form demonstrated validity and reliability across US and UK MS populations. • A preliminary minimal important difference estimate and score interpretation guidance are provided. A valid, sensitive patient-reported outcome (PRO) measure of physical function (PF) for people with multiple sclerosis (MS) would have substantial value in routine care and clinical research. We now describe development of the PROMISnq Short Form v2.0 PF – Multiple Sclerosis 15a [PROMISnq PF(MS)15a] for assessing PF in relapsing and progressive MS. Also, the validity, reliability, and responsiveness of the PROMISnq PF(MS)15a is evaluated, minimal important difference (MID) thresholds for score change estimated and a score interpretation guide developed. A mixed-methods sequential design was employed. Relevant PF concepts were elicited through semi-structured interviews with people with relapsing MS, and then mapped to the PROMIS PF item bank. Measurement experts integrated results from interviews with people with MS and input from a panel of neurologists to generate a draft short form. Relevance and comprehensiveness of the draft short form were assessed in cognitive debriefing interviews with people with relapsing or progressive MS. Subsequently, item reduction and evaluation of psychometric properties were performed in two observational studies: a cross-sectional study in the US (n = 296), and a 96-week longitudinal study in the UK MS Register cohort (n = 558). The main outcomes and measures are estimates of: known-groups validity, convergent validity, reliability, responsiveness; MID for worsening. Factor analyses supported the unidimensionality of the newly derived 15-item short form. Cronbach's alpha (≥ 0.97) and intraclass correlation coefficient (≥ 0.97) of test-retest scores (5–27 days) indicated strong reliability. Convergent validity was demonstrated by moderate-to-strong correlations with scores on related PRO measures. Scores discriminated among patient groups classified by levels of physical health and other criteria. Score changes of 2.3–2.7 points are proposed as MID criteria for minimal worsening in PF. PROMISnq PF(MS)15a demonstrated reliability, validity and sensitivity to change. Input from patients and clinicians ensured the content is comprehensive and relevant for people with MS. [ABSTRACT FROM AUTHOR]

Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. Therefore, NIH Pain Consortium charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimum dataset to describe research participants (drawing heavily on the PROMIS methodology); reporting 'responder analyses' in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect that the RTF recommendations will become a dynamic document and undergo continual improvement. Perspective: A task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes. [ABSTRACT FROM AUTHOR]

Language facilitates communication and efficient encoding of thought and experience. Because of its essential role in early childhood development, in educational achievement and in subsequent life adaptation, language was included as one of the subdomains in the NIH Toolbox for the Assessment of Neurological and Behavioral Function Cognition Battery (NIHTB-CB). There are many different components of language functioning, including syntactic processing (i.e., morphology and grammar) and lexical semantics. For purposes of the NIHTB-CB, two tests of language—a picture vocabulary test and a reading recognition test—were selected by consensus based on literature reviews, iterative expert input, and a desire to assess in English and Spanish. NIHTB-CB’s picture vocabulary and reading recognition tests are administered using computer adaptive testing and scored using item response theory. Data are presented from the validation of the English versions in a sample of adults ages 20–85 years (Spanish results will be presented in a future publication). Both tests demonstrated high test–retest reliability and good construct validity compared to corresponding gold-standard measures. Scores on the NIH Toolbox measures were consistent with age-related expectations, namely, growth in language during early development, with relative stabilization into late adulthood. (JINS, 2014, 20, 1–10) [ABSTRACT FROM PUBLISHER]

Purpose: The assessment of pain sensation and quality is a key component in understanding the experience of individuals with chronic pain. This study evaluated the factor structure of the patient-reported outcome measurement information system (PROMIS) pain quality item bank. Methods: As part of the PROMIS project, we developed a pool of 37 pain quality items, based on a review of existing pain questionnaires and development of new items. A web-based survey was designed and completed by 845 members of the general population and 967 individuals with different types of chronic pain. Exploratory factor analysis (EFA) was conducted on a random split-half sample of the data to examine the factor structure of the 37 PROMIS pain quality items in the general population and in a chronic pain sample. A confirmatory factor analysis was conducted in the holdout sample. Results: The EFA of the pain quality items resulted in comparable six-factor solutions for the general and chronic pain samples: (1) pulling/tugging pain; (2) tingling/numbness pain; (3) sharp/stabbing pain; (4) dull/aching pain; (5) pounding/pulsing pain; and (6) affective pain. The confirmatory factor analysis in the holdout sample supported this factor structure. Conclusions: Further research is needed to evaluate the psychometric characteristics of the derived scales based on their factor scores. [ABSTRACT FROM AUTHOR]

Purpose: In order to test the difference between group means, the construct measured must have the same meaning for all groups under investigation. This study examined the measurement invariance of responses to the patient-reported outcomes measurement information system (PROMIS) pain behavior (PB) item bank in two samples: the PROMIS calibration sample (Wave 1, N = 426) and a sample recruited from the American Chronic Pain Association (ACPA, N = 750). The ACPA data were collected to increase the number of participants with higher levels of pain. Methods: Multi-group confirmatory factor analysis (MG-CFA) and two item response theory (IRT)-based differential item functioning (DIF) approaches were employed to evaluate the existence of measurement invariance. Results: MG-CFA results supported metric invariance of the PROMIS-PB, indicating unstandardized factor loadings with equal across samples. DIF analyses revealed that impact of 6 DIF items was negligible. Conclusions: Based on the results of both MG-CFA and IRT-based DIF approaches, we recommend retaining the original parameter estimates obtained from the combined samples based on the results of MG-CFA. [ABSTRACT FROM AUTHOR]

Highlights: [•] We produced cross-walk tables linking three popular instruments to PROMIS Anxiety. [•] The scores of our common measure (PROMIS Anxiety) are centered on the 2000 US census. [•] Users can directly compare clinical scores obtained on multiple measures of anxiety. [•] Clinical means or cut-off scores were close to one SD above the population mean. [Copyright &y& Elsevier]

Abstract: Pain behaviors that are maintained beyond the acute stage after injury can contribute to subsequent psychosocial and physical disability. Critical to the study of pain behaviors is the availability of psychometrically sound pain behavior measures. In this study we developed a self-report measure of pain behaviors, the Pain Behaviors Self Report (PaB-SR). PaB-SR scores were developed using item response theory and evaluated using a rigorous, multiple-witness approach to validity testing. Participants included 661 survey participants with chronic pain and with multiple sclerosis, back pain, or arthritis; 618 survey participants who were significant others of a chronic pain participant; and 86 participants in a videotaped pain behavior observation protocol. Scores on the PaB-SR were found to be measurement invariant with respect to clinical condition. PaB-SR scores, observer reports, and the videotaped protocol yielded distinct, but convergent views of pain behavior, supporting the validity of the new measure. The PaB-SR is expected to be of substantial utility to researchers wishing to explore the relationship between pain behaviors and constructs such as pain intensity, pain interference, and disability. [Copyright &y& Elsevier]

Introduction: To help researchers in multiple sclerosis (MS) take advantage of the measurement properties of the PROMIS Pain Interference instrument while maintaining continuity with previous research, we developed and tested a crosswalk table to transform Brief Pain Inventory pain interference scale (BPI-PI) scores to PROMIS-PI short form (PROMIS-PI SF) scores. Methods: The BPI-PI and the PROMIS-PI SF were administered in two studies that included persons with MS. One sample of 369 participants served as a developmental calibration sample, and a separate sample of 360 served as a validation sample. The crosswalk development included dimensionality assessment, item-level parameter estimation, and assessment of accuracy. BPI-PI and PROMIS-PI T scores were obtained from participants’ item responses, and using the crosswalk table, PROMIS-PI T scores were derived from responses to the BPI-PI items. Differences between observed and crosswalked T scores were compared in both samples. Results: For BPI-PI summary scores ranging from 0 to 10, corresponding T scores ranged from 38.6 to 81.2. The mean difference between observed and crosswalked T scores was 0.51 (SD = 3.9) in the calibration sample and −1.47 (SD = 4.2) in the validation sample. Approximately 80 % of crosswalked scores in the calibration sample were within four score points of the observed PROMIS-PI SF scores, and 70 % were within four points in the validation sample. In both samples, the largest differences were at lower levels of the pain interference continuum. Conclusions: Crosswalked pain interference scores adequately approximated observed PROMIS-PI SF scores in both the calibration and validation samples. MS researchers and clinicians interested in adopting the PROMIS instruments can use this table to transform BPI-PI scores to enable comparisons with other studies and to maintain continuity with previous research. [ABSTRACT FROM AUTHOR]

Context: Pain is a common and complex experience for individuals who live with multiple sclerosis (MS) and it interferes with physical, psychological, and social function. A valid and reliable tool for quantifying observed pain behaviors in MS is critical to understand how pain behaviors contribute to pain-related disability in this clinical population. Objectives: To evaluate the reliability and validity of a pain behavioral observation protocol in individuals who have MS. Methods: Community-dwelling volunteers with MS (N =30), back pain (N =5), or arthritis (N =8) were recruited based on clinician referrals, advertisements, fliers, web postings, and participation in previous research. Participants completed the measures of pain severity, pain interference, and self-reported pain behaviors and were videotaped doing typical activities (e.g., walking and sitting). Two coders independently recorded frequencies of pain behaviors by category (e.g., guarding and bracing) and interrater reliability statistics were calculated. Naïve observers reviewed videotapes of individuals with MS and rated their pain. The Spearman's correlations were calculated between pain behavior frequencies and self-reported pain and pain ratings by naïve observers. Results: Interrater reliability estimates indicated the reliability of pain codes in the MS sample. Kappa coefficients ranged from moderate (sighing=0.40) to substantial agreements (guarding=0.83). These values were comparable with those obtained in the combined back pain and arthritis sample. Concurrent validity was supported by correlations with self-reported pain (0.46–0.53) and with self-reports of pain behaviors (0.58). Construct validity was supported by a finding of 0.87 correlation between total pain behaviors observed by coders and mean pain ratings by naïve observers. Conclusion: Results support the use of the pain behavior observation protocol for assessing pain behaviors of individuals with MS. Valid assessments of pain behaviors of individuals with MS could lead to creative interventions in the management of chronic pain in this population. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the measurement invariance of responses to the patient-reported outcomes measurement information system (PROMIS) pain interference (PI) item bank. The original PROMIS calibration sample (Wave I) was augmented with a sample of persons recruited from the American Chronic Pain Association (ACPA) to increase the number of participants reporting higher levels of pain. Establishing measurement invariance of an item bank is essential for the valid interpretation of group differences in the latent concept being measured. Methods: Multi-group confirmatory factor analysis (MG-CFA) was used to evaluate successive levels of measurement invariance: configural, metric, and scalar invariance. Results: Support was found for configural and metric invariance of the PROMIS-PI, but not for scalar invariance. Conclusions and recommendations: Based on our results of MG-CFA, we recommend retaining the original parameter estimates obtained by combining the community sample of Wave I and ACPA participants. Future studies should extend this study by examining measurement equivalence in an item response theory framework such as differential item functioning analysis. [ABSTRACT FROM AUTHOR]

Abstract: Amtmann D, Bamer AM, Cook KF, Askew RL, Noonan VK, Brockway JA. University of Washington Self-Efficacy Scale: a new self-efficacy scale for people with disabilities. Objective: To develop a self-efficacy scale for people living with multiple sclerosis (MS) and spinal cord injury (SCI) that can be used across diagnostic conditions. Design: The scale was developed using modern psychometric methods including item response theory. Items were administered at 3 time-points of a longitudinal survey of individuals with MS and SCI. Setting: Survey participants with MS were recruited from the National MS Society, and participants with SCI were recruited from the Northwest Regional Spinal Cord Injury Model System and the Shepherd Center at the Virginia Crawford Research Institute in Atlanta, GA. Participants: Adults aged 18 years and older reporting a definitive diagnosis of MS (N=473) or SCI (N=253). Interventions: None. Main Outcome Measures: Evaluation of the new self-efficacy measure called the University of Washington Self-Efficacy Scale (UW-SES) included comparisons with the Chronic Disease Self-Efficacy Scale and other patient-reported outcome measures. Results: UW-SES has excellent psychometric properties including well-functioning response categories, no floor effects, and low ceiling effects. A long form (17 items) and a short form (6 items) are available. The correlation between the score on the newly developed scale and the Chronic Disease Self-Efficacy Scale was high (.83), providing support for convergent validity. Higher self-efficacy scores were statistically significantly associated with better mental health, better physical health, less fatigue, less stress, less pain interference, less pain, fewer sleep problems, and lower depressive symptoms. Conclusions: The UW-SES is a psychometrically sound instrument for measuring self-efficacy, validated in MS and SCI, and can be used across both conditions. Both the long form and the short form are available free of charge. [Copyright &y& Elsevier]

Purpose: To create cross-walk tables to associate scores for the Modified Fatigue Impact Scale (MFIS) with scores for the Patient Reported Outcome Measurement Information System (PROMIS) Fatigue Short Form (SF) in persons with Multiple Sclerosis (MS). Methods: Cross-walk tables were created using equipercentile linking and based on data collected at one time point in a longitudinal study of persons with MS ( N = 458). Validation of the tables was conducted using data collected at a subsequent time point ( N = 444). Deviations between estimates and actual scores were compared across levels of fatigue. The impact of sample size on the precision of sample mean estimates was evaluated using bootstrapping. Results: Correlations between deviations and fatigue level for the PROMIS Fatigue SF and MFIS were (−0.31) and (−0.30), respectively, indicating moderately greater deviations with lower fatigue scores. Estimated sample means were impacted by sample size. Conclusions: Cross-walk tables allow data from studies using different measures of fatigue to be combined to achieve larger sample sizes and to compare results. These tables are valid for group-level analyses with sample sizes of 150 or greater. [ABSTRACT FROM AUTHOR]

Purpose: To derive from the Patient Reported Outcomes Measurement Information System (PROMIS) fatigue item bank, a short form for individuals with multiple sclerosis (MS), the PROMIS-Fatigue. Methods: A panel of 37 clinicians and 46 individuals with MS ranked the relevance of PROMIS fatigue items to persons with MS. Eight items were selected for the PROMIS-Fatigue that maximized relevance rankings, content coverage, and item discrimination. The PROMIS-Fatigue and an existing, 7-item PROMIS fatigue short form (PROMIS-Fatigue) were administered to a new sample of 231 individuals with MS. Known groups and content validity were assessed. Results: Scores from the short forms were highly correlated ( r = 0.92). Discriminant validity of the PROMIS-Fatigue scores was supported in known groups comparisons. Scores of neither short form exhibited an advantage in quantitative analyses. The PROMIS-Fatigue targeted more of the content included in participants' responses to open-ended questions than did the PROMIS-Fatigue. Conclusions: The PROMIS-Fatigue was derived to have content validity in MS samples. The validity of the measure was further supported by the ability of PROMIS-Fatigue items to discriminate among groups expected to differ in levels of fatigue. We recommend its use in measuring the fatigue of individuals with MS. [ABSTRACT FROM AUTHOR]

Abstract: Cook KF, Molton IR, Jensen MP. Fatigue and aging with a disability. Objective: To compare self-reported fatigue in 4 disability populations with age-matched, U.S. population norms. We assessed fatigue and age in a sample of individuals with spinal cord injury (SCI), postpolio syndrome (PPS), multiple sclerosis (MS), and muscular dystrophy (MD). Design: This study used survey responses and published age cohort means for fatigue to test the hypothesis that fatigue would be higher in each of 4 clinical samples than the U.S. population norm. We also hypothesized that, for clinical samples, the mean fatigue reported within age cohorts would be higher than the general U.S. population norms for those age ranges derived in the Patient-Reported Outcomes Measurement Information System (PROMIS). Setting: Survey responses were collected from participants in the Washington state area. Participants: Participants (N=1836) were persons with MD (n=337), MS (n=580), Post-polio (n=441), and SCI (n=478). Interventions: Not applicable. Main Outcome Measure: PROMIS Depression Short Form. Results: Individuals with disabilities reported higher levels of fatigue than the normative PROMIS population. In the normative population, self-reported fatigue was substantially lower in age cohorts from middle age to retirement age. However, individuals with disabilities did not demonstrate this age cohort effect. Conclusions: Individuals with disabilities are not only at greater risk to experience fatigue, but this risk, relative to normative values, increases with age. More research is needed to determine the specific negative impact of fatigue symptoms on functioning in individuals with disabilities as they age. [Copyright &y& Elsevier]

Abstract: Cook KF, Bombardier CH, Bamer AM, Choi SW, Kroenke K, Fann JR. Do somatic and cognitive symptoms of traumatic brain injury confound depression screening? Objective: To evaluate whether items of the Patient Health Questionnaire 9 (PHQ-9) function differently in persons with traumatic brain injury (TBI) than in persons from a primary care sample. Design: This study was a retrospective analysis of responses to the PHQ-9 collected in 2 previous studies. Responses to the PHQ-9 were modeled using item response theory, and the presence of DIF was evaluated using ordinal logistic regression. Setting: Eight primary care sites and a single trauma center in Washington state. Participants: Participants (N=3365) were persons from 8 primary care sites (n=3000) and a consecutive sample of persons with complicated mild to severe TBI from a trauma center who were 1 year postinjury (n=365). Interventions: Not applicable. Main Outcome Measure: PHQ-9. Results: No PHQ-9 item demonstrated statistically significant or meaningful DIF attributable to TBI. A sensitivity analysis failed to show that the cumulative effects of nonsignificant DIF resulted in a systematic inflation of PHQ-9 total scores. Therefore, the results also do not support the hypothesis that cumulative DIF for PHQ-9 items spuriously inflates the numbers of persons with TBI screened as potentially having major depressive disorder. Conclusions: The PHQ-9 is a valid screener of major depressive disorder in people with complicated mild to severe TBI, and all symptoms can be counted toward the diagnosis of major depressive disorder without special concern about overdiagnosis or unnecessary treatment. [Copyright &y& Elsevier]

The purpose of this postscript is to comment on psychometric issues raised by the collective articles of this special issue of the Journal of Applied Measurement. Topics discussed include the need to engage relevant literature in the psychometric and larger academic communities, the role of measurement models in psychometrics, and challenges to efficient measurement of patient reported outcomes. Finally, I argue that psychometrics should play "second fiddle" to larger scientific questions. [ABSTRACT FROM AUTHOR]

A real-data simulation of computerized adaptive testing (CAT) is an important step in real-life CAT applications. Such a simulation allows CAT developers to evaluate important features of the CAT system, such as item selection and stopping rules, before live testing. SIMPOLYCAT, an SAS macro program, was created by the authors to conduct real-data CAT simulations based on polytomous item response theory (IRT) models. In SIMPOLYCAT, item responses can be input from an external file or generated internally on the basis of item parameters provided by users. The program allows users to choose among methods of setting initial θ, approaches to item selection, trait estimators, CAT stopping criteria, polytomous IRT models, and other CAT parameters. In addition, CAT simulation results can be saved easily and used for further study. The purpose of this article is to introduce SIMPOLYCAT, briefly describe the program algorithm and parameters, and provide examples of CAT simulations, using generated and real data. Visual comparisons of the results obtained from the CAT simulations are presented. [ABSTRACT FROM AUTHOR]

Background: In the development of health outcome measures, the pool of candidate items may be divided into multiple forms, thus "spreading" response burden over two or more study samples. Item responses collected using this approach result in two or more forms whose scores are not equivalent. Therefore, the item responses must be equated (adjusted) to a common mathematical metric. Objectives: The purpose of this study was to examine the effect of sample size, test size, and selection of item response theory model in equating three forms of a health status measure. Each of the forms was comprised of a set of items unique to it and a set of anchor items common across forms. Research Design: The study was a secondary data analysis of patients' responses to the developmental item pool for the Health of Seniors Survey. A completely crossed design was used with 25 replications per study cell. Results: We found that the quality of equatings was affected greatly by sample size. Its effect was far more substantial than choice of IRT model. Little or no advantage was observed for equatings based on 60 or 72 items versus those based on 48 items. Conclusions: We concluded that samples of less than 300 are clearly unacceptable for equating multiple forms. Additional sample size guidelines are offered based on our results. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted to evaluate the relationship among patient outcome expectancies, perceived shoulder function changes, and perceptions of expectancy fulfillment. Methods: Patients (n = 199) treated for shoulder problems at one orthopedic surgeon's office completed a baseline survey comprised of measures of outcome expectancies, shoulder function, health status, and demographics. At 1 month, 2 months, and 3 months, patients completed a mailed follow-up survey comprised of all baseline measures except demographic variables. At 3 months, a measure of expectancy fulfillment was added. A general linear modeling approach was used to assess the significance and effect size of 1) outcome expectancies on changes in shoulder function; and (2) outcome expectancies, shoulder function changes, and their interaction on perceptions of expectancy fulfillment. Results: Outcome expectancies significantly predicted changes in shoulder function and accounted for 10% of the variance in functional improvement. The improvement difference between patients with high expectancies compared with those with low expectancies was clinically relevant (4.57 points), as it was greater than the minimal clinically important difference (3.02 points). Outcome expectancies and shoulder function changes significantly predicted patients' perceptions of fulfilled expectancies, but their interaction was not statistically significant. Conclusions: Results highlight the importance of patient expectancy in medical encounters. The findings suggest the need for interventions targeting patient expectancies such as including discussions about expectancy in patient-physician negotiations of therapeutic plans. Results also underscore the need for the development of better measures of outcome expectancies and expectancy fulfillment. [ABSTRACT FROM AUTHOR]