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Objective: To examine the reliability, validity, responsiveness, and minimal important difference of the 4-m gait speed test in acute respiratory distress syndrome survivors.Design: Secondary analyses of data from two longitudinal follow-up studies of acute respiratory distress syndrome survivors. Test-retest and inter-rater reliability, construct validity (convergent, discriminant, and known group), predictive validity, and responsiveness were examined. The minimal important difference was estimated using anchor- and distribution-based approaches.Setting: A national multicenter prospective study (ARDSNet Long-Term Outcome Study) and a multisite prospective study in Baltimore, MD (Improving Care of Acute Lung Injury Patients).Patients: Acute respiratory distress syndrome survivors with 4-m gait speed assessment up to 60 months after acute respiratory distress syndrome (ARDSNet Long-Term Outcome Study, n = 184; Improving Care of Acute Lung Injury Patients, n = 122).Interventions: Not applicable.Measurements and Main Results: Four-meter gait speed was assessed at 6- and 12-month follow-up (ARDSNet Long-Term Outcome Study) and 36-, 48-, and 60-month follow-up (Improving Care of Acute Lung Injury Patients). Excellent test-retest (intraclass correlation, 0.89-0.99 across studies and follow-up) and inter-rater (intraclass correlation, 0.97) reliability were found. Convergent validity was supported by moderate-to-strong correlations (69% of 32 > 0.40) with other physical function measures. Discriminant validity was supported by weak correlations (86% of 28 < 0.30) with mental health measures. Survivors with impaired versus nonimpaired measures of muscle strength and pulmonary function had significantly slower 4-m gait speed (all but one p < 0.05). Furthermore, 4-m gait speed significantly predicted future hospitalization and health-related quality of life. Gait speed changes were consistent with reported changes in function, supporting responsiveness. The estimated 4-m gait speed minimal important difference was 0.03-0.06 m/s.Conclusions: The 4-m gait speed is a reliable, valid, and responsive measure of physical function in acute respiratory distress syndrome survivors. The estimated minimal important difference will facilitate sample size calculations for clinical studies evaluating the 4-m gait speed test in acute respiratory distress syndrome survivors. [ABSTRACT FROM AUTHOR]

Objective: To harmonize measures of cognitive performance using item response theory (IRT) across two international aging studies. Method: Data for persons ≥65 years from the Health and Retirement Study (HRS, N = 9,471) and the English Longitudinal Study of Aging (ELSA, N = 5,444). Cognitive performance measures varied (HRS fielded 25, ELSA 13); 9 were in common. Measurement precision was examined for IRT scores based on (a) common items, (b) common items adjusted for differential item functioning (DIF), and (c) DIF-adjusted all items. Results: Three common items (day of date, immediate word recall, and delayed word recall) demonstrated DIF by survey. Adding survey-specific items improved precision but mainly for HRS respondents at lower cognitive levels. Discussion: IRT offers a feasible strategy for harmonizing cognitive performance measures across other surveys and for other multi-item constructs of interest in studies of aging. Practical implications depend on sample distribution and the difficulty mix of in-common and survey-specific items. [ABSTRACT FROM AUTHOR]

Background: Patients requiring skilled home health care (HH) after hospitalization are at high risk of adverse events. Human factors engineering (HFE) approaches can be useful for measure development to optimize hospital-to-home transitions. Objective: To describe the development, initial psychometric validation, and feasibility of the Hospitalto-Home-Health-Transition Quality (H3TQ) Index to identify patient safety risks. Methods: Development: A multisite, mixed-methods study at 5 HH agencies in rural and urban sites across the United States. Testing: Prospective H3TQ implementation on older adults’ hospital-to-HH transitions. Populations Studied: Older adults and caregivers receiving HH services after hospital discharge, and their HH providers (nurses and rehabilitation therapists). Results: The H3TQ is a 12-item count of hospital-to-HH transitions best practices for safety that we developed through more than 180 hours of observations and more than 80 hours of interviews. The H3TQ demonstrated feasibility of use, stability, construct validity, and concurrent validity when tested on 75 transitions. The vast majority (70%) of hospital-to-HH transitions had at least one safety issue, and HH providers identified more patient safety threats than did patients/caregivers. The most frequently identified issues were unsafe home environments (32%), medication issues (29%), incomplete information (27%), and patients’ lack of general understanding of care plans (27%). Conclusions: The H3TQ is a novel measure to assess the quality of hospital-to-HH transitions and proactively identify transitions issues. Patients, caregivers, and HH providers offered valuable perspectives and should be included in safety reporting. Study findings can guide the design of interventions to optimize quality during the high-risk hospital-to-HH transition. [ABSTRACT FROM AUTHOR]

Hoyer EH, Brotman DJ, Chan KS, Needham DM: Barriers to early mobility of hospitalized general medicine patients: survey development and results. Am J Phys Med Rehabil 201 5 ;94 :3 0 4 -3 1 2. Objective: Functional status decline commonly accompanies hospitalization making patients vulnerable to complications. Such decline can be mitigated through hospital-based early mobility programs. Success in implementing patient mobility quality improvement processes requires evaluating providers' knowledge, attitudes, and behaviors. Design: A cross-sectional, self-administered survey in two different hospital settings was completed by 1 20 nurses and physical and occupational therapists (rehabilitation therapists, 38; nurses, 82) from six general medicine units. The survey was developed using published guidelines, literature review, and provider meetings and refined through pilot testing. Psychometric properties were assessed, and regression analyses were conducted to examine barriers to early mobility by hospital site, provider discipline, and years of experience. Results: Internal consistency reliability, item consistency, and discriminant validity psychometric characteristics were acceptable. In multivariable regression analysis, overall perceived barriers were similar between the two hospitals (P = 0.25) and significantly higher for staff with less experience (P = 0.02) and for nurses vs. rehabilitation therapists (P < 0.001 ).The survey identified specific barriers common to both nurses and rehabilitation therapists and other barriers that were discipline specific. Conclusions: This novel survey identified important barriers to mobilizing medical inpatients that were similar across two hospital settings. These results can assist with the implementation of quality improvement projects for increasing early hospital-based patient mobility. [ABSTRACT FROM AUTHOR]

The present study extends the item-level psychometric information of the Leeds Dependence Questionnaire (LDQ; Raistrick et al., 1994) that has been purported to measure psychological dependence and the International Statistical Classification of Diseases and Related Health Problems-10th edition substance dependence criteria. Prior research on the LDQ has not established item-level properties or the degree of differential item functioning (DIF) by gender and substance type. Principal component and Mokken scale analyses were used to assess unidimensionality and monotonicity of the responses to the scale items, respectively. Graphical and statistical methods examined the model-data fit of the graded response model and two-parameter logistic model of LDQ responses (n = 1,681) obtained from 2 community treatment centers. DIF analysis was performed on gender (men = 1,313, women = 353) and substance (alcohol = 821, opiates = 528) groups. The 2PL achieved the best model-data fit. Three items provided little information about standing on the underlying construct, indicating that they are likely not good indicators of the "pure" psychological construct the LDQ aims to measure. Overall, the LDQ offers the greatest precision in quantifying psychological dependence in a clinical sample along the lower to mid ranges of this construct. Uniform DIF was present in Item 7 of the dichotomized responses by substance (alcohol vs. opiates). DIF by gender was not found in any of the LDQ items. Recommendations include revising the scaling and discussing the need to obtain LDQ data from different levels of care and primary identified substance. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Objectives: To review the evidence supporting the validity of health literacy (HL) measures for ethnic minority populations.Methods: PubMed, CINAHL, and PsycINFO databases were searched for HL measures between 1965 and 2013.Results: A total of 109HL measures were identified; 37 were non-English HL measures and 72 were English language measures. Of the 72 English language measures, 17 did not specify the racial/ethnic characteristic of their sample. Of the remaining 55 measures, 10 (18%) did not include blacks, 30 (55%) did not include Hispanics, and 35 (64%) did not include Asians in their validation sample. When Hispanic and Asian Americans were included, they accounted for small percentages in the overall sample. Between 2005-2013, a growing number of REALM and TOFHLA translations were identified, and new HL measures for specific cultural/linguistic groups within and outside the United States were developed.Conclusions: While there are a growing number of new and translated HL measures for minority populations, many existing HL measures have not been properly validated for minority groups.Practice Implications: HL measures that have not been properly validated for a given population should be piloted before wider use. In addition, improving HL instrument development/validation methods are imperative to increase the validity of these measures for minority populations. [ABSTRACT FROM AUTHOR]

There are currently more than 100 health literacy instruments. The procedures used to develop and test the measures are primarily guided by classical test theory. However, a small and growing number (n = 13) of health literacy measures are guided by modern measurement theories such as item response theory. This article briefly describes (a) the benefits of using modern measurement approaches for the development of health literacy measures, (b) how these approaches have been used with existing health literacy measures, and (c) some considerations for how modern measurement theory can help strengthen future work in health literacy measurement. Ultimately, this article provides evidence to support an assertive shift toward the use of modern measurement approaches in health literacy instrument development. [ABSTRACT FROM PUBLISHER]