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Psychometrics of three Swedish physical pediatric item banks from the Patient-Reported Outcomes Measurement
Frida Carlberg Rindestig1, Marie Wiberg2, John Eric Chaplin3
1Department of Clinical Science, Child- and Adolescent Psychiatry, Umeå University, 90185, Umeå, Sweden.
Insights
Swedish translations of the Patient-Reported Outcomes Measurement Information System (PROMIS®) physical health item banks for pain, fatigue, and physical activity demonstrate adequate psychometric properties for pediatric use in school and clinical settings.
Area of Science:
- Pediatric Health Outcomes
- Psychometrics
- Health Services Research
Background:
- The Patient-Reported Outcomes Measurement Information System (PROMIS®) develops item banks for health dimensions.
- Swedish pediatric versions of PROMIS Physical Health item banks for pain interference, fatigue, and physical activity were investigated.
- Physical health is crucial for adolescent well-being, impacting somatic and mental conditions.
Purpose of the Study:
- To investigate the psychometric properties of Swedish pediatric PROMIS Physical Health item banks.
- To validate translations for use in Swedish school health care and clinical pediatric settings.
Main Methods:
- 12- to 19-year-old participants (n=681) were recruited from schools and clinics.
- Confirmatory Factor Analysis (CFA) evaluated scale dimensionality.
- Item Response Theory (IRT) models, including graded response model and Differential Item Functioning (DIF) analyses for age, gender, and language, were applied.
Main Results:
- CFA supported unidimensionality for each item bank.
- IRT analyses identified 11 items with lack of fit, and DIF was found for age (7 items) and language (9 items).
- Despite some DIF and lack of fit, item fit differences and effect sizes were negligible, leading to the decision to retain all items.
Conclusions:
- Swedish translations of PROMIS item banks for pain interference, fatigue, and physical activity were validated using CFA, IRT, and DIF analyses.
- The psychometric properties suggest the translated questionnaires are adequate for use in Swedish school health and pediatric care.
- Future research may explore Computerized Adaptive Testing (CAT) for efficient assessment.
Background:
The Patient-Reported Outcomes Measurement Information System (PROMIS®) aims to provide self-reported item banks for several dimensions of physical, mental and social health. Here we investigate the psychometric properties of the Swedish pediatric versions of the Physical Health item banks for pain interference, fatigue and physical activity which can be used in school health care and other clinical pediatric settings. Physical health has been shown to be more important for teenagers' well-being than ever because of the link to several somatic and mental conditions. The item banks are not yet available in Sweden.
Methods:
12- to 19-year-old participants (n = 681) were recruited in public school settings, and at a child- and psychiatric outpatient clinic. Three one-factor models using CFA were performed to evaluate scale dimensionality. We analyzed monotonicity and local independence. The items were calibrated by fitting the graded response model. Differential Item analyses (DIF) for age, gender and language were calculated.
Results:
As part of the three one-factor models, we found support that each item bank measures a unidimensional construct. No monotonicity or local dependence were found. We found that 11 items had significant lack of fit in the item response theory (IRT) analyses. The result also showed DIF for age (seven items) and language (nine items). However, the differences on item fits and effect sizes of McFadden were negligible. After considering the analytic results, graphical illustration, item content and clinical relevance we decided to keep all items in the item banks.
Conclusions:
We translated and validated the U.S. PROMIS item banks pain interference, fatigue and physical activity into Swedish by applying CFA, IRT and DIF analyses. The results suggest adequacy of the translations in terms of their psychometrics. The questionnaires can be used in school health and other pediatric care. Future studies can be to use Computerized Adaptive Testing (CAT), which provide fewer but reliable items to the test person compared to classical testing.
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