Development of a Rasch-Calibrated Test for Assessing Implied Meaning in Patients With Schizophrenia

Shih-Chieh Lee; Kuan-Wei Chen; Chien-Yu Huang; Pei-Chi Li; Ton-Lin Hsieh; Ya-Chen Lee; I-Ping Hsueh

doi:10.5014/ajot.2022.047316

Development of a Rasch-Calibrated Test for Assessing Implied Meaning in Patients With Schizophrenia

Am J Occup Ther. 2022 Jul 1;76(4):7604205020. doi: 10.5014/ajot.2022.047316.

Authors

Shih-Chieh Lee¹, Kuan-Wei Chen², Chien-Yu Huang³, Pei-Chi Li⁴, Ton-Lin Hsieh⁵, Ya-Chen Lee⁶, I-Ping Hsueh⁷

Affiliations

¹ Shih-Chieh Lee, PhD, is Postdoctoral Researcher, Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Adjunct Assistant Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; and Adjunct Assistant Professor, Institute of Long-Term Care, MacKay Medical College, New Taipei City, Taiwan. At the time this article was submitted, Lee was Postdoctoral Researcher, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
² Kuan-Wei Chen, PhD, is Occupational Therapist, Department of Occupational Therapy, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan, and Adjunct Assistant Professor, Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.
³ Chien-Yu Huang, PhD, is Assistant Professor, School of Occupational Therapy, College of Medicine, and Adjunct Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan. At the time this article was submitted, Huang was Associate Professor, Department of Occupation Therapy, I-Shou University, Kaohsiung, Taiwan.
⁴ Pei-Chi Li, MS, is PhD Student, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan. At the time this article was submitted, Li was Master's Student, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁵ Ton-Lin Hsieh, BA, is Master's Student, Department of Psychology, National Taiwan University, Taipei, Taiwan. At the time this article was submitted, Hsieh was Research Assistant, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁶ Ya-Chen Lee, PhD, is Assistant Professor, Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taiwan; jennyleenet@asia.edu.tw.
⁷ I-Ping Hsueh, MS, is Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, and Adjunct Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; iping@ntu.edu.tw.

PMID: 35861611
DOI: 10.5014/ajot.2022.047316

Abstract

Importance: Patients with schizophrenia tend to have severe deficits in theory of mind, which may limit their interpretation of others' behaviors and thereby hamper social participation. Commonly used measures of theory of mind assess the ability to understand various social situations (e.g., implied meaning or hinting, faux pas), but these measures do not yield valid, reliable, and gender unbiased results to inform interventions for managing theory-of-mind deficits. We used understanding of implied meaning, which appears to be a unidimensional construct highly correlated with social competence, as a promising starting point to develop a theory-of-mind assessment.

Objective: To develop a Rasch-calibrated computerized test of implied meaning.

Design: Cross-sectional design.

Setting: Psychiatric hospitals and community.

Participants: 344 participants (240 patients with schizophrenia and 104 healthy adults).

Results: We initially developed 27 items for the Computerized Implied Meaning Test. After inappropriate items (12 misfit items and 1 gender-biased item) were removed, the remaining 14 items showed acceptable model fit to the Rasch model (infit = 0.84-1.16; outfit = 0.65-1.34) and the one-factor model (comparative fit index = .91, standardized root mean square residual = .05, root-mean-square error of approximation = .08). Most patients (81.7%) achieved individual Rasch reliability of ≥.90. Healthy participants performed significantly better on the test than patients with schizophrenia (Cohen's d = 2.5, p < .001).

Conclusions and relevance: Our preliminary findings suggest that the Computerized Implied Meaning Test may provide reliable, valid, and gender-unbiased results for patients with schizophrenia. What This Article Adds: We developed a new measure for assessing theory-of-mind ability in patients with schizophrenia that consists of items targeting the understanding of implied meaning. Preliminary findings suggest that the Computerized Implied Meaning Test is reliable, valid, and gender unbiased and may be used in evaluating patients' theory-of-mind deficits and relevant factors.

MeSH terms

Adult
Cross-Sectional Studies
Humans
Psychometrics
Reproducibility of Results
Schizophrenia*
Surveys and Questionnaires

Grants and funding

KSPH-2014-37/Kaohsiung Municipal Kai-Syuan Psychiatric Hospital