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The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool
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The e-MSWS-12: improving the multiple sclerosis walking scale using item response theory.

Matthew M Engelhard1, Karen M Schmidt2, Casey E Engel3

  • 1Department of Systems and Information Engineering, University of Virginia, P.O. Box 400747, Charlottesville, VA, 22904, USA. mme@virginia.edu.

Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation
|June 26, 2016
PubMed
Summary
This summary is machine-generated.

Item response theory (IRT) analysis of the Multiple Sclerosis Walking Scale (MSWS-12) improved measurement accuracy and identified items needing revision for better multiple sclerosis (MS) walking assessments.

Keywords:
12-Item multiple sclerosis walking scaleDifferential item functioningGraded response modelItem response theoryMultiple sclerosisTimed 25-foot walk

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Area of Science:

  • Rehabilitation Medicine
  • Biostatistics
  • Health Outcomes Research

Background:

  • The Multiple Sclerosis Walking Scale (MSWS-12) is a key patient-reported outcome for assessing walking ability in multiple sclerosis (MS).
  • Existing validation of the MSWS-12 has not incorporated item response theory (IRT), a standard for patient-reported outcome (PRO) analysis.
  • This study addresses the need for IRT analysis to refine the MSWS-12 and enable advanced applications like computerized adaptive testing.

Purpose of the Study:

  • To develop an IRT model for the MSWS-12 to reduce measurement error.
  • To facilitate the creation of computerized adaptive testing (CAT) for the MSWS-12.
  • To provide an online platform for IRT-based scoring and analysis of the MSWS-12.

Main Methods:

  • Collected MSWS-12 responses from 284 individuals with MS via mail.
  • Fitted and compared various IRT models, selecting a one-dimensional graded response model (GRM).
  • Assessed model fit, item performance using category response curves (CRCs), and tested for differential item functioning (DIF) based on age and sex.

Main Results:

  • The selected GRM fit the data well, explaining 87% of response variance.
  • IRT-based MSWS-12 scores showed strong correlation with traditional scores (r=0.99) and timed 25-foot walk (T25FW) speed (r=-0.70).
  • Differential item functioning (DIF) was detected in Item 2 (age) and Item 11 (sex), indicating potential biases.

Conclusions:

  • MSWS-12 measurement error is influenced by walking ability and can be reduced by refining or replacing items with low information or DIF.
  • An online tool (e-MSWS-12) was developed, offering IRT-based scoring, error checking, and T25FW estimation.
  • The e-MSWS-12 is accessible online to aid in the assessment of MS-related walking difficulties.