Application of Rasch Analysis to Timed Instrumental Activities of Daily Living in Low Vision: A Validation Study

Abstract

Significance: This work validates Rasch analysis of a performance-based low vision outcome measure evaluated in patients' own homes to ensure real-world relevance. Inclusion of sources of variance from the patient's home environment in functional outcome measures introduced nonuniform variance in measurements but did not preclude estimation of valid measures.

Purpose: This study aimed to validate Rasch analysis of a performance-based outcome measure with real-world relevance.

Methods: Low vision patients (N = 161) receiving services from an occupational therapist performed Timed Instrumental Activity of Daily Living (TIADL) tasks in their homes. Rasch analysis was applied to error count and performance time data. Internal validity was assessed with evaluations of the accuracy and precision of estimated measures. External validity was assessed by comparing TIADL measures with measures estimated from the Activity Inventory (i.e., from self-reported difficulty ratings).

Results: Task measures were well targeted to person measures estimated from task performance time but were poorly targeted for measures estimated from task performance errors, for which most task trials (72%) were performed without error at baseline. Error-based person measures had larger standard errors with a smaller pseudo- R2 than time-based person or task measures and error-based task measures. Person measure infits for time- and error-based estimates conformed to expected values. The linear regressions between time-based person and task measures and corresponding error-based estimates had slopes of approximately 0.5, an observation consistent with larger estimation error variance for error-based measures than for time-based measures. Time-based TIADL person measures ( x ) and Activity Inventory person measures (estimated from all items, y ) were colinear but weakly correlated ( R = 0.19).

Conclusions: Functional ability measures estimated from performance times of instrumental activity of daily living tasks in patients' homes demonstrate good internal and external validity. The ceiling effect from the infrequency of task performance errors in our data set limits use of TIADL error data to measure rehabilitation outcomes.