University of Cambridge > > Cambridge Psychometrics Centre Seminars > Using Rasch Analysis in Neurological and Community Rehabilitation - The SARDINE Project (Secondary Analysis of Routine Data in Neurorehab Evaluations)

Using Rasch Analysis in Neurological and Community Rehabilitation - The SARDINE Project (Secondary Analysis of Routine Data in Neurorehab Evaluations)

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If you have a question about this talk, please contact Luning Sun.

On the Matilda Bay Club website Ben Wright commented “as long as primitive counts and raw scores are routinely mistaken for measures by our colleagues in Social, Educational and Health research, there is no hope of their professional activities ever developing into a reliable or useful science. We owe it to them, and to ourselves, to teach them how to construct measures which work as well as the ubiquitous physical measures by which they manage their everyday living, so that they can do a better job in making sense out of the profusions of data which they collect so enthusiastically”. [Wright 1999]

As an NHS Manager I am indeed faced with “profusions of data” and having benefited from “how to” analysis training, I have been working away to understand the Patient Reported Outcomes we are collecting routinely in the various clinical settings in Cambridgeshire Community Services NHS Trust.

At the Oliver Zangwill Centre for Neuropsychological Rehabilitation we have examined the properties a brain injury symptom checklist (the EBIQ ), the Dysexecutive Questionnaire (DEX), a self-criticism tool, and most recently an assessment of emotion perception. These have been with relatively small sample sizes. In the wider community services the generic Health Related Quality of Life tool the EQ5D -5L has been adopted, with a substantial flow of data (>500 patients per month).

In each case the benefits of a Rasch approach have been clear: 1) examination of category probability curves and demonstration of disordered thresholds points to the difficulties many patients have distinguishing between the Likert categories conceived by questionnaire designers. The outcomes enable a reasoned approach to item re-scoring 2) item properties revealed by tests of Item Bias have uncovered DIF that has provided interesting insights into changes between cultures, pathologies and age-groups. 3) evaluation of the targetting of a tool contributes to the confidence one can have in the assessments we are using. The analyses enable improvements in the tools, in the scoring of the tools and prioritisation of services. I will illustrate each of these points.

In each case the findings have been both clinically informative at the same time as challenging measurement assumptions underlying the tools. The overall objective is to achieve a mapping of the outcome space for community rehabilitation and to be able to describe changes that are achieved by our patients.

The challenges ahead include the need to automate analyses for clinical activity monitoring, to explain the findings clearly and thereby enable NHS service efficiency. Wider collaboration between the clinical and psychometric communities is encouraged.

This talk is part of the Cambridge Psychometrics Centre Seminars series.

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