TY - JOUR
T1 - Comprehensive ADL Outcome Measurement after Stroke
T2 - Rasch Validation of the Lucerne ICF-Based Multidisciplinary Observation Scale (LIMOS)
AU - Van de Winckel, Ann
AU - Ottiger, Beatrice
AU - Bohlhalter, Stephan
AU - Nyffeler, Thomas
AU - Vanbellingen, Tim
N1 - Funding Information:
Supported by the Swiss National Science Foundation (grant nos. T.N. 320030_140696 and 320030_169789).
Publisher Copyright:
© 2019 American Congress of Rehabilitation Medicine
PY - 2019/12
Y1 - 2019/12
N2 - Objective: To establish Rasch validation of the Lucerne International Classification of Functioning, Disability and Health (ICF)-based Multidisciplinary Observation Scale (LIMOS) in stroke. LIMOS measures the level of assistance in daily life activities related to motor function, communication, cognition, and domestic life. Rasch Measurement Theory (RMT) transforms an ordinal scale into an interval scale and thus the Rasch-based LIMOS scale captures a more accurate improvement of functional outcomes via Rasch-transformed scores. Design: Cross-sectional study design. Setting: Neurorehabilitation center, Luzerne, Switzerland. Participants: We recruited participants with stroke (N=407; age=63.2±16.0y; n=157 women) through consecutive sampling. Interventions: Not applicable. Main Outcome Measures: Participants were assessed with LIMOS at admission and discharge of rehabilitation. We used RMT to evaluate overall model fit, response dependency, floor and ceiling effect, reliability, and differential item functioning (DIF) for sex, age, type, and time of stroke on the 4 LIMOS subscales using the Rasch Unidimensional Measurement Model (RUMM) 2030 program. Results: The Rasch-based LIMOS subscales fit the Rasch model after reducing and rescoring items: motor (from 20 to 18 items), communication (5 items), cognition (from 15 to 13 items), and domestic life (5 items). There was no floor or ceiling effect. Some artificial DIF was identified. Scoring at discharge was dependent on the scoring responses at admission, which means that without applying a correction factor to the discharge scores, there was an underestimation of change in scores between admission and discharge, ranging from 0.24 to 0.97 logits (10.79%-49.24%) on the different subscales. Conclusions: The Rasch-based LIMOS scale is recommended to measure functional outcome in people with acute or chronic stages of ischemic or hemorrhagic stroke.
AB - Objective: To establish Rasch validation of the Lucerne International Classification of Functioning, Disability and Health (ICF)-based Multidisciplinary Observation Scale (LIMOS) in stroke. LIMOS measures the level of assistance in daily life activities related to motor function, communication, cognition, and domestic life. Rasch Measurement Theory (RMT) transforms an ordinal scale into an interval scale and thus the Rasch-based LIMOS scale captures a more accurate improvement of functional outcomes via Rasch-transformed scores. Design: Cross-sectional study design. Setting: Neurorehabilitation center, Luzerne, Switzerland. Participants: We recruited participants with stroke (N=407; age=63.2±16.0y; n=157 women) through consecutive sampling. Interventions: Not applicable. Main Outcome Measures: Participants were assessed with LIMOS at admission and discharge of rehabilitation. We used RMT to evaluate overall model fit, response dependency, floor and ceiling effect, reliability, and differential item functioning (DIF) for sex, age, type, and time of stroke on the 4 LIMOS subscales using the Rasch Unidimensional Measurement Model (RUMM) 2030 program. Results: The Rasch-based LIMOS subscales fit the Rasch model after reducing and rescoring items: motor (from 20 to 18 items), communication (5 items), cognition (from 15 to 13 items), and domestic life (5 items). There was no floor or ceiling effect. Some artificial DIF was identified. Scoring at discharge was dependent on the scoring responses at admission, which means that without applying a correction factor to the discharge scores, there was an underestimation of change in scores between admission and discharge, ranging from 0.24 to 0.97 logits (10.79%-49.24%) on the different subscales. Conclusions: The Rasch-based LIMOS scale is recommended to measure functional outcome in people with acute or chronic stages of ischemic or hemorrhagic stroke.
KW - Activities of daily living
KW - Outcome measures
KW - Rasch
KW - Rehabilitation
KW - Stroke
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U2 - 10.1016/j.apmr.2019.02.012
DO - 10.1016/j.apmr.2019.02.012
M3 - Article
C2 - 30928303
AN - SCOPUS:85064667583
SN - 0003-9993
VL - 100
SP - 2314
EP - 2323
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 12
ER -
