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Simplifying ICF Assessment for Individuals With Spinal Cord Injury With Lower-Limb Dysfunction Using Item Response
Huifang He1, Wenjun Dai2, Min Su3
1Department of Rehabilitation Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China; School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China.
Objective:
To develop and validate a parameterized assessment tool based on the International Classification of Functioning, Disability and Health (ICF) for individuals with spinal cord injury (SCI) with lower-limb dysfunction by applying item response theory (IRT) and graphical modeling (GM).
Design:
Cross-sectional, multicenter study.
Setting:
Multiple rehabilitation centers in China.
Participants:
A total of 252 participants with SCI and lower-limb dysfunction.
Interventions:
Not applicable.
Main Outcome Measures:
Participants were assessed using the ICF questionnaire, the Lower Extremity Motor Score, the Spinal Cord Independence Measure, the Short Form-12 Health Survey, and the Modified Barthel Index. We used Mokken scale analysis and parametric item response modeling to evaluate these items. Furthermore, we employed IRT to develop both nonparametric IRT and parametric IRT models for psychometric measurement. To further investigate the complex relationships among ICF functional items and its interventional implications, we applied GM to visualize the network structure of functional categories and computed the Overall Benefit Index.
Results:
The 4-parameter logistic model, comprising 38 ICF items, was identified as the optimal model. This model demonstrated good reliability, with a Cronbach's α coefficient of 0.9445 and a Latent Class Reliability Coefficient of 0.9708. The estimated person ability parameter (θ) showed significant positive correlations with external measures. The results also confirmed the measurement equivalence of the final model across different genders, levels of self-care ability, clinical stages, and age groups. GM indicated that interventions targeting key functional items, such as d420 (Transferring Oneself) and d415 (maintaining a body position) were expected to produce significant overall functional benefits for patients.
Conclusions:
The 38-item ICF-based assessment tool demonstrated good structural validity and internal consistency. It holds significant potential for informing functional assessment and formulating individualized intervention strategies for this population.
