Psychometric evaluation of a new measure of fear avoidance behavior after mild traumatic brain injury using Rasch Analysis.
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Résumé
IntroductionFear avoidance is a known risk factor for chronic disability after musculoskeletal injury and has been shown to be associated with a range of adverse outcomes after mild traumatic brain injury (MTBI). A psychometrically valid measure of fear avoidance behavior after MTBI could help advance the field. In this study, we examined the psychometric properties of a 16-item fear avoidance behavior questionnaire in a sample of people after MTBI. The Fear Avoidance Behavior in Traumatic Brain Injury questionnaire (FAB-TBI) is comprised of items from existing fear avoidance behavior measures (primarily in chronic pain literature), selected on the basis of principal component and factor analyses in prior studies, and presented with uniform Likert-type response options. Ordinal scales may not discriminate precisely between fear avoidance behaviors across individuals. The current study aimed to improve precision and item functioning of the FAB-TBI by applying Rasch analysis.Materials and MethodsAdults (n=120) who were recruited from outpatient clinics in Vancouver and Calgary following MTBI completed the FAB-TBI at a median of six weeks post-injury (IQR 4-8). First, using Classical Test Theory methods we examined item-total correlations, Cronbachu2019s u03b1 and dimensionality. We used Principal components and Varimax rotation to explore dimensionality. Second, we used Rasch analysis to determine overall and individual item fit to the Rasch model, differential item functioning (DIF), local independence, unidimensionality and person-separation reliability of the FAB-TBI using RUMM2030 software.ResultsParticipants were on average 39 years old (SD 12.5), predominantly Caucasian (68%), with slightly more women (61%) than men. The most common injury mechanism was motor vehicle accident (39%). FAB-TBI item-total correlations were all above 0.3, Cronbachu2019s u03b1=0.9, and we observed a clear four-factor structure (activity avoidance, general pain concern, headache avoidance, general symptom avoidance). Initial analysis indicated the FAB-TBI demonstrated adequate but not perfect fit with the Rasch model with one misfitting item. Best fit to the unidimensional Rasch model was achieved after locally dependent items were combined into four subtests based on the initial exploratory factor analysis, retaining the misfitting item (Chi square=3.4, df 8, p=0.9). Finally the modified FAB-TBI demonstrated high internal consistency (Person Separation Index=0.8); there was no DIF across person factors examined. There was DIF by recruitment site, but this finding was unstable, requiring further evaluation. The results support retaining the original response format and content of the measure. From these analyses we created ordinal-to-interval conversion tables that will allow more precise assessment of fear avoidance behavior across individuals on an interval scale.Conclusions:With minor modifications, the FAB-TBI demonstrated adequate properties as a unidimensional scale. Rasch analyses supported the FAB-TBI as a psychometrically sound measure of fear avoidance behavior in adults after MTBI, with potential to assist clinicians develop targeted MTBI interventions.
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Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,009 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,004 | 0,001 |
| Bibliométrie | 0,114 | 0,096 |
| Études des sciences et des technologies | 0,000 | 0,002 |
| Communication savante | 0,003 | 0,015 |
| Science ouverte | 0,011 | 0,004 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,030 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle