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Dimensionality was inves- and LAI-knee. Misfitting items were present in both the tigated with a factor analysis. Raw scores underwent Rasch scales.
According to both CTT and Rasch analysis, in our analysis. LAI-hip resulted in unidimensionality and knee OA severity the LAI-hip and LAI-knee showed a series of drawbacks, which rendered both question- naires inadequate in relation to their metric properties and severely limit their ability to perform, as a composite F.
Franchignoni : A. Giordano : M. Ottonello measure, in line with the main aims of their developers. Outcome measure. Rasch analysis A. Giordano e-mail: andrea. Ottonello e-mail: marcella. Knee and hip OA are Department of Rheumatology, common causes of lower extremity pain and disability in the Politechnic University of the Marche, general population . Patients with lower extremity OA Ancona, Italy exhibit deterioration in functions concerning mobility, transfer e-mail: fsalaff tin.
Pain and disability have a significant impact on health-related quality of life and social M. Carotti costs . In evaluating the severity of OA of the lower limbs, Department of Radiology, guidelines for outcome measurement in OA highlight the Politechnic University of the Marche, Ancona, Italy need to evaluate at least three dimensions: pain, global e-mail: marina. In The exclusion criteria were as follows: concurrent the last decade, the disease-specific questionnaires Western systemic inflammatory rheumatic disease, medical comor- Ontario and McMaster Universities OA index  or the bidity that would render the patient unable to participate derived Hip Disability and Osteoarthritis Outcome Score  fully in study procedures e.
All OA patients had radiographs of their affected joints. The Lequesne Algofunctional Indexes for severity of OA Radiographs of the knees were anteroposterior AP of the hip LAI-hip and knee LAI-knee each consist of three weight-bearing, semiflexed view, whereas an AP pelvis sections with a total of 11 questions: severity of pain five radiograph was collected on hip patients. The radiographs items , walking ability two items and physical function four used in this study were generally obtained within 1 year items.
In spite of positive psychometric validations per- from the date of the questionnaire assessments. Among them, the study on LAI-hip by Dawson et al. A the hip LAI-hip and knee LAI-knee include three sections Rasch analysis evaluates the psychometric properties of a which are not graded separately and take a few minutes to questionnaire that are not analysed by CTT techniques, e. Rasch analysis is being increasingly used in the walking aids as an 11th question item 6b in Tables 1 and 2 development and evaluation of clinical tools for health care, [17, 18].
For the purposes of this study we chose to use the and the advantages of this approach have been documented self-administered format because in clinical trials it allows for in the literature [26, 27]. The aim of this study was to mailing to patients. Both Lequesne indexes are scored as the perform a comprehensive psychometric analysis of both sum of all items, resulting in a total score ranging from 0 to LAI-hip and LAI-knee, using both CTT and Rasch analysis, Higher scores denote greater OA severity.
Statistical analysis Patients and methods A stage process was used to investigate the basic properties of LAI-hip and LAI-knee: Patients and data collection Internal consistency and dimensionality In this cross-sectional survey, the disease-specific LAI-hip and LAI-knee questionnaires were completed by 1, patients The items were examined for internal consistency calculating: with symptomatic OA of the knees patients or hips patients , enrolled by general practitioners participating in the 1.
Study . According to the American College of recommended for group level comparisons, whereas a Rheumatology guidelines, the inclusion criteria [29, 30] for minimum of 0. The Spearman rank correlation coefficients rs , to than 30 min, and crepitation in the knee or 2 pain for more examine to what degree each item was correlated with than 25 days of the past 30 days and osteophytes on X-ray the total score, omitting that item from the total item— examination of the knees .
Patients with hip OA who were total correlation, corrected for item overlap. During nocturnal bed rest 1. During nocturnal bed rest None or insignificant 0 None or insignificant 0 Only on movement or on certain positions 1 Only on movement or on certain positions 1 With no movement 2 With no movement 2 2. Morning stiffness or regressive pain after rising 2. Morning stiffness or regressive pain after rising 1 min or less 0 1 min or less 0 More than 1 but less than 15 min 1 More than 1 but less than 15 min 1 15 min or more 2 15 min or more 2 3.
After standing for 30 min 3. After standing for 30 min No 0 No 0 Yes 1 Yes 1 4. While ambulating 4. While ambulating None 0 None 0 Only after ambulating some distance, or after 1 Only after ambulating some distance or after initial 1 initial ambulation, not increasingly ambulation, not increasingly Early after initial ambulation and increasingly with 2 Early after initial ambulation and increasingly with 2 continued ambulation continued ambulation 5.
With prolonged sitting 2 h 5. When getting up from sitting without the help of arms None 0 None 0 Yes 1 Yes 1 Maximum distance walked may walk with pain Maximum distance walked may walk with pain 6a. Maximum distance walked 6a. Maximum distance walked Unlimited 0 Unlimited 0 More than 1 km but limited 1 More than 1 km but limited 1 About 1 km or about 15 min 2 About 1 km or about 15 min 2 From to 1, m or 8—15 min 3 From to 1, m or 8—15 min 3 From to m 4 From to m 4 From to m 5 From to m 5 Less than m 6 Less than m 6 6b.
Use of a walking aid 6b. Use of a walking aid None 0 None 0 One walking stick or crutch 1 One walking stick or crutch 1 Two walking sticks or crutches 2 Two walking sticks or crutches 2 Activities of daily living Activities of daily living 7. Put on socks by bending forward 7. Able to climb up a standard flight of stairs? Pick up an object from the floor 8. Able to climb down a standard flight of stairs?
Climb up and down a standard flight of stairs 9. Able to squat or bend on the knees? Get into and out of a car or a deep armchair Able to walk on uneven ground? Without difficulty 0 Without difficulty 0 With some difficulty 0. The following criteria FACTOR : were used to determine whether additional factors were likely to be present in the residuals: a a cutoff 1. The local independence of items. High correlation single dimension.
After a review of the rating scale categories, the Rasch analysis validity was analysed by evaluating the fit of individual items of each index LAI-hip and LAI-knee to the latent After the above analysis, the matrix of single raw trait as per the Rasch modelling unidimensionality and scores for each subject underwent Rasch analysis examining if the pattern of item difficulties was consis- partial credit model through the WINSTEPS software, tent with the model expectation.
The Rasch model v. The information-weighted both LAI-hip and LAI-knee were being used in the infit and outlier-sensitive outfit mean-square statistics expected manner, according to the criteria suggested by MnSq for each item were calculated similar to a chi- Linacre [25, 38]. If necessary, according to the findings square analysis to test if there were items which did not of the rating scale diagnostic, categories were collapsed fit with the model expectancies .
The following step reliability indices and clinical meaning . We also measurement error . The separation indices give an assessed the possible differences in item functioning DIF estimate in standard error units of the spread or linked to gender or age. A separation a different manner to an individual item, so that item of 2.
The mean age of the sample was Of the patients, Of the 1, 1. The presence of subdimensions, as an independent enrolled subjects, The item total correlation coefficients ranged from 0. Pre-set criteria were met when the seven categories were collapsed into a Fig.
The same applies for the other curves. The ideal structure variance explained by the Rasch factor LAI-knee plot should look—as in b—like an ordered even succession of hills, To confirm this finding, scale after collapsing into five categories, according to the model in partial disagreement with the results of the EFA for LAI- see text.
The overfit Table 1. Figure 2a shows the distribution map of residual correlation test showed an inter-item correlation subject ability and item difficulty of the LAI-hip.
The item higher than 0. The item Clin Rheumatol — Fig. The vertical line represents the measure of Each item is indicated by its number see Table 1. By convention, the OA severity, with the units of measurement on the scale logits, the average difficulty of items in the test is set at 0 logits and indicated with natural logarithm of the odds of mutually exclusive alternatives, e.
Figure 2b 0. Moreover, the item weighting seem arbitrary. The category thresholds are construct model fit. The Cronbach alpha 0. Our findings knee. A similar reliability was found with the Rasch indicate that subjects were able to distinguish only five analysis person separation reliability , with results rang- categories instead of the original seven levels , and thus, ing from 0. The internal it might be appropriate to simplify the item format. In addition, the use mentioned that among all the questions this was the least of the raw score seems inappropriate because items have comprehensible .
As for the fit of individual items to very different rating points, not properly weighted. The most used approaches are derived from underfitting.
This indicates that both LAI scales have the factor analysis: EFA is used to study the relevant latent items that either do not tap the same underlying construct factors after some form of estimation of their number and or are poorly written or too sensitive to confounding the contribution of individual items to those traits in new or factors.
For example, it is reasonable that unexpected modified models e. In any case, we think that an instrument for examining information over that provided by other items in the scale, the severity of hip and knee OA should separately rate and with a response pattern too predictable from the overall functional difficulty and functional pain .
This inter-item dependency indicates that Minosi Armando, Miserocchi Fabio, Moreno Mauro, Muratore either they duplicate some feature of each other or they Maurizio, Murgo Antonella, Ortolani Sergio, Olivieri Ignazio, Paolazzi both incorporate some other shared dimension.
Moreover, if some items are removed, this could reduce the breadth, precision and reliability of both scales. Disclosures None Our study has a number of limitations.
The algofunctional indices for hip and knee osteoarthritis.
Internally, a combination formula of Unani herbs was administered, which was as follows: Risk factors for progression of knee osteoarthritis. From This Paper Figures, tables, and topics from this paper. Showing of 26 references. Welcome to our Lequesne Algofunctional Index Application!
How Physical Function Is Assessed for Osteoarthritis
Validity, reliability, and comparison of the WOMAC osteoarthritis index and Lequesne algofunctional index in Turkish patients with hip or knee osteoarthritis. Clinical rheumatology, 29 7 , Doyle Index is a valuable additional pain measure in osteoarthritis. Osteoarthritis and Cartilage, 18 8 ,
How Physical Function Is Assessed for Osteoarthritis
Indexes of severity for osteoarthritis of the hip and knee. Research design considerations for confirmatory chronic pain clinical trials: Degenerative polyarthritis Hip structure. Externally, the concoction of Gule baboona 20 g and Gule tesu 40 g made in algfunctional l water was poured over the affected knee, daily once for 40 days. Nonsteroidal antiinflammatory drugs in rheumatoid arthritis and osteoarthritis: JetteChristine M.