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ORIGINAL REPORT
139
F. Franchignoni et al.
indicator of acceptable fit MnSq >0.6 and <1.4: items outside this
range were considered misfitting (MnSq 1.4) or overfitting (MnSq
0.6) (see below) (30).
The next step in the Rasch analysis was to calculate the level of
difficulty achieved by each item (item-difficulty) and where each
individual subject fits along the continuum (subject ability). Itemdifficulty and patient ability are expressed on a common interval
scale in logit units, a logit being the natural logarithm of the ratio
(odds) of mutually exclusive alternatives (e.g. pass vs fail, or higher
vs lower response) (17, 30).
Finally, to test the construct validity of the Rasch-refined version
of the PEQ-MS, we correlated its score with LCI and other PPA items
(Spearmans rs, corrected for ties) (27), hypothesizing a good to excellent correlation with LCI (the constructs measured by the 2 scales
are both related to ability in locomotor activities with the prosthesis)
and a fair to moderate degree of relationship with the other PPA items
measuring factors associated with prosthetic wear and use (25).
to measure (MnSq between 0.6 and 1.4) (Table III). The item
Shower/bathe was misfitting (Infit MnSq=1.59; Outfit
Mnsq=1.55). The revised scale including only the 12 items
of the PEQ-MS fitting the Rasch model (all but the item
Shower/bathe) constitutes a new Rasch-refined instrument
with an original 5-level response format, the PEQ-MS12/5
(see Appendix).
The reliability indices for the PEQ-MS before and after
the phase of rating-scale modification and item reduction are
shown in Table IV. The reliability indices of PEQ-MS12/5
presented comparable values with those of the PEQ-MS; all
item and person reliabilities were 0.95. The items of both
versions were distributed into more than 10 difficulty strata.
(A)
RESULTS
1
0
Category Probability
10
0.8
0.6
0.4
5
0.2
0
-6
-5
-4
-3
-2
-1
10
12
1
0
Category Probability
140
0.8
1
0.6
0.4
0.2
0
Value (IQR)
54 (3665)
74
8 (514)
38 (1848)
J Rehabil Med 39
35
56
9
53
36
11 (6% above both knee)
28
72
-12
-10
-8
-6
-4
-2
141
Table II. Prosthesis Evaluation Questionnaire Mobility Section (PEQ-MS) before (left, 11 categories) and after (right, 5 categories) the collapsing
procedure (n = 118 persons with non-extreme measures): frequencies, average category measures (mean ability of subjects getting a given score)
and thresholds (step calibration, ability level at which adjacent scores are equally likely)
PEQ-MS with 11 categories
71
65
67
99
100
161
136
122
162
226
325
5
4
4
6
7
10
9
8
11
15
21
Average
measure
1.41
1.09
0.73
0.33
0.21
0.02
0.46
0.61
0.93
1.47
2.37
Step calibration
None
1.20
0.93
1.00
0.33
0.52
0.42
0.63
0.54
0.88
1.52
71
231
SE
Infit
MnSq
Outfit
MnSq
2.35
1.92
1.44
0.29
0.15
0.15
0.15
0.15
1.24
0.87
0.75
1.16
1.30
0.88
0.76
1.12
0.24
0.36
0.41
0.41
0.54
0.66
0.15
0.15
0.16
0.16
0.16
0.16
1.59
0.82
0.90
0.83
0.92
1.23
1.55
0.77
0.92
0.81
0.85
1.19
0.87
1.11
1.97
0.16
0.16
0.17
0.91
0.98
0.89
0.88
1.01
0.82
Measure
Average
measure
3.06
Step calibration
15
1.56
3.52
397
26
0.21
1.20
510
33
2.17
0.91
325
21
4.70
3.81
None
PEQ-MS
PEQ-MS12/5
7.48
0.98
4.20
0.95
0.96
7.90
0.98
4.15
0.95
0.96
142
F. Franchignoni et al.
Patient's
ability measures
Itemdifficulty measures
REFERENCES
1. Geertzen JH, Martina JD, Rietman HS. Lower limb amputation.
Part 2: rehabilitation a 10 year literature review. Prosthet Orthot
Int 2001; 25: 1420.
2. Rommers GM, Vos LD, Groothoff JW, Eisma WH. Mobility of
people with lower limb amputations: scales and questionnaires: a
review. Clin Rehabil 2001; 15: 92102.
3. Brooks D, Hunter JP, Parsons J, Livsey E, Quirt J, Devlin M. Reliability of the two-minute walk test in individuals with transtibial
amputation. Arch Phys Med Rehabil 2002; 83: 15621565.
4. Schoppen T, Boonstra A, Groothoff J, de Vries J, Geken LNH,
Eisma WH. The Timed up and go test: reliability and validity
in persons with unilateral lower limb amputation. Arch Phys Med
Rehabil 1999; 80: 825828.
5. Deathe AB, Miller WC. The L test of functional mobility: measurement properties of a modified version of the timed up & go
test designed for people with lower-limb amputations. Phys Ther
2005; 85: 626635.
6. Gailey RS, Roach KE, Applegate EB, Cho B, Cunniffe B, Licht
S, et al. The Amputee Mobility Predictor: an instrument to assess
determinants of the lower-limb amputees ability to ambulate. Arch
Phys Med Rehabil 2002; 83: 613627.
7. Miller WC, Deathe AB, Speechley M. Lower extremity prosthetic
mobility: a comparison of 3 self-report scales. Arch Phys Med
Rehabil 2001; 82: 14321440.
8. Devlin M, Pauley T, Head K, Garfinkel S. Houghton Scale of prosthetic use in people with lower-extremity amputations: reliability,
validity, and responsiveness to change. Arch Phys Med Rehabil
2004; 85: 13391344.
9. Legro MW, Reiber GD, Smith DG, del Aguila M, Larsen J, Boone
D. Prosthesis Evaluation Questionnaire for persons with lower limb
amputation; assessing prosthesis-related quality of life. Arch Phys
Med Rehabil 1998; 79: 931938.
10. Gauthier-Gagnon C, Grise MC. Prosthetic profile of the amputee
questionnaire: validity and reliability. Arch Phys Med Rehabil
1994; 75: 13091314.
11. McColl E, Jacoby A, Thomas L, Soutter J, Bamford C, Steen N,
et al. Design and use of questionnaires: a review of best practice
applicable to surveys of health service staff and patients. Health
Technol Assess 2001; 5: 1256.
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144
F. Franchignoni et al.
APPENDIX
The revised Prosthesis Evaluation Questionnaire Mobility Section, PEQ-MS12/5, the newly proposed scale for measuring mobility in people with
lower limb amputation (LLA) wearing a prosthesis. The scale includes the 12 items of the PEQ-MS fitting the Rasch model, rated with a 5-level
scale.
Over the past 4 weeks, please rate your ability in the following activities when using your prosthesis:
Check for each statement
1. To walk
2. To walk in confined spaces
3. To walk upstairs
4. To walk downstairs
5. To walk up a steep hill
6. To walk down a steep hill
7. To walk on sidewalks and streets
8. To walk on slippery surfaces (e.g. wet tile,
snow, a rainy street, or a boat deck)
9. To get in and out of a car
10. To sit down and get up from a chair with
a high seat (e.g. a dining chair, an office
chair)
11. To sit down and get up from a low, soft
chair (e.g. a deep sofa)
12. To sit down and get up from the toilet of
regular height (no aids)
J Rehabil Med 39
Unable
or hardly able at all
(ability < 5%)
(0)
High
difficulty
Moderate difficulty
(ability 534%) (ability 3564%)
(1)
(2)
Little
difficulty
(ability 6595%)
(3)
No problems
or almost fully able
(ability > 95%)
(4)