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A Rasch Analysis of the Frenchay Activities Index in Patients With Spinal Cord Injury

Hsieh, Ching-Lin, PhD*; Jang, Yuh, MPH*; Yu, Tzu-Ying, BS*; Wang, Wen-Chung, PhD; Sheu, Ching-Fan, PhD; Wang, Yen-Ho, MD§

doi: 10.1097/01.brs.0000255095.08523.39
Cervical Spine
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Study Design. A prospective interview study.

Objective. To determine whether items of the Frenchay Activities Index (FAI) measure Instrumental Activities of Daily Living (IADL), as a unidimensional construct, in patients with spinal cord injury (SCI). To examine whether the response categories of the FAI are useful in discerning the various ability levels of IADL.

Summary of Background Data. No known IADL scale has been designed for SCI patients. The FAI, to our knowledge, has never been validated in patients with SCI.

Methods. A total of 233 persons with SCI participated in this study. The FAI was administered to the patients by interview at locations convenient for the participants. A Rasch analysis was used to examine the unidimensionality and appropriateness of the response categories of the FAI.

Results. All but 2 items (“going outside” and “reading books”) of the FAI fitted the model's expectations. The results of Rasch analysis indicated that the response categories for the remaining 13 items of the FAI should be collapsed to create more suitable response categories (4 items, into dichotomies, and the remaining 9 items, into trichotomies). Thus, a revised 13-item FAI was formed by deleting the 2 misfitting items and collapsing the response categories of the items.

Conclusions. This study demonstrated that the revised 13-item FAI assesses a single, unidimensional IADL for SCI patients living in the community. The revised FAI shows potential for assessment of IADL in SCI patients.

This is the first study to use Rasch analysis to validate and revise an Instrumental Activities of Daily Living scale (in this case, the Frenchay Activities Index) in patients with spinal cord injury.

From the *School of Occupational Therapy, College of Medicine, National Taiwan University and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital; †Department of Psychology, National Chung Cheng University; ‡Institute of Cognitive Science, National Cheng Kung University; and §Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.

Acknowledgment date: June 3, 2005. First revision date: December 1, 2005. Second revision date: March 3, 2006. Third revision date: May 22, 2006. Acceptance date: May 23, 2006.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Other funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

This study was supported by the National Health Research Institute in Taiwan (NHRI-EX94-9204PP).

Address correspondence and reprint requests to Ching-Lin Hsieh, PhD, School of Occupational Therapy, College of Medicine, National Taiwan University, No. 7, Chung-Shan S. Rd, Taipei 100, Taiwan; E-mail: mike26@ha.mc.ntu.edu.tw

© 2007 Lippincott Williams & Wilkins, Inc.