This study investigated the association between family socioeconomic status, family race/ethnicity, quality of services and the impact of those services on the family for families who had participated in a northeastern state's IDEA, Part C Early Intervention Program. Data for this study came from 1,108 families who responded to a survey distributed by the state's Early Intervention Program. The survey contained two Rasch-based measurement scales designed to yield measures of family perceptions of the quality of early intervention services they had received and the impact of those services on their family. Results of the study indicated that measures of quality of services were significantly and positively related to family outcomes. However, neither family race/ethnicity nor socioeconomic status was associated with quality of services. Results related to the strong association between quality of services and positive family outcomes are interpreted in light of previous research on the outcomes of family-centered care models. Results related to the parity of service quality across racial/ethnic and socioeconomic groups are interpreted in relation to two important characteristics of high-quality programs: cultural competency and service coordination.

Background: Among the instruments commonly used by occupational therapists working in the area of rehabilitation of persons with neurological disorders are evaluations of both occupation, such as activities of daily living (ADL), and body functions. While persons with neurological diagnoses typically have symptoms that represent diminished neurobehavioral functions, the resulting pattern of neurobehavioral impairments affecting ADL performance often differs among diagnostic groups. Usually, neurobehavioral impairments are evaluated in a context that is separate from and not natural for ADL task performance. The A-ONE is a unique instrument that can be used to evaluate both ADL performance (ADL scale) and, in the natural context of the ADL task performance, the underlying neurobehaviors that cause diminished ADL task performance among persons with neurological disorders (Neurobehavioral scale). The scales of the instrument are of ordinal type, and in their existing form, do not have measurement properties. Measurement properties are a requirement of evidence-based and quality assured rehabilitation services. The overall aim of this doctoral study was to further develop and validate the A-ONE. This included (a) internal validation to explore the potential for converting the ordinal scales of the instrument to interval scales, (b) examination of which of the neurobehavioral items would be most beneficial and clinically useful for constructing a new Neurobehavioral Impact (NBI) scale for evaluating persons with different neurological diagnoses, and (c) exploration of whether persons with right and left cerebrovascular accidents (RCVA, LCVA) differ in mean NBI measures.  Methods: This thesis is comprised of four studies which all contribute in different ways to the validation of the scales of the A-ONE. In the first three studies, Rasch analyses, a widely accepted modern test theory methodology, was used to examine internal validity of the scales and the reliability of the A-ONE measures. In the fourth study, ANCOVA was used to explore between group differences, and Pearson correlation coefficients were used to explore relations between person measures from the different A-ONE scales. Results: The first study of 209 persons diagnosed with CVA and dementia provided support for converting the ordinal ADL scale to an interval scale that has potential to be used to measure change in ADL performance over time. The second and third studies, including 206 and 422 persons respectively, indicated that it is possible to construct several unidimensional versions of a new NBI scale from the neurobehavioral items of the instrument, each with different item content and hierarchical item structure. Further, some of these NBI scales could be used across different diagnostic groups. When exploring differences between 215 persons with RCVA and LCVA on the NBI scale developed for CVA, results of the ANCOVA (with ADL ability as a covariate) indicated that there is no significant difference between groups in their mean NBI measures, despite known differences in patterns of neurobehavioral impairments. Conclusions: The results of this thesis indicate that the A-ONE, although developed by traditional psychometric methods for the purpose of providing useful information for intervention planning, now also has the potential to be used to measure change and compare diagnostic groups. This additional feature will likely enhance both clinical and research potential of the instrument. In order to make the results of the study accessible for clinicians, conversion tables need to be developed.

The overall aim of this thesis was to examine the construct validity and the reliability of the instrument DOA; Dialogue about working ability. The theoretical foundation for DOA is the Model of Human Occupation. The instrument is divided into two sections; client self-assessment and professional assessment focusing on the individual’s working ability. The assessments are followed by a dialogue to distinguish goals for the return to-work process based on the client’s own preferences. In line with the theoretical base, the concept ‘work’ refers to both paid work and other productive activities related to work. In Study I, 21 professionals and 126 clients participated from three clinics in Sweden. All clients were involved as outpatients in psychiatric work rehabilitation in county councils or community services. The results from the Rasch analysis test indicated that items are well separated from each other and generally work together in five unidimensional continuums with the objective to measure abilities related to work. Twenty-nine of 34 items showed goodness-of-fit statistics, which means acceptable infit MnSq values from >0.6 to <1.4 in association with Z values from –2 to 2, and that the five misfit items have to be revised. Thirty-four outpatient clients and 14 professionals from four clinics within psychiatric work rehabilitation in Sweden participated in Study II. Two reliability aspects were studied: test-retest and inter rater reliability. The statistical analyses used were Spearman Rank Correlation test and Percentage of agreement (PA). Generally, the Spearman Rank Correlation test showed acceptable significant correlations between test retest since a greater part of items correlated “moderate to good” (r = 0.51 – 0.75). In the inter raters´ test PA was good, ranging from 93.1 % to 96.5 %, which is well above the acceptable criteria of 80 %. There were no significance differences between the raters. The study has shown that one item has to revised. The findings verify that DOA has potential as a means of making valid and reliable assessments of working ability, as described by the Model of Human Occupation, out of both clients´ and occupational therapists´ perspective.

Objective. The overall aim of this thesis was to evaluate the biopsychosocial consequences after stroke and test the validity of the ICF Core Sets for Stroke during one year post-stroke. Material and Methods. Studies I, II and III were based on data from a prospective cohort study with 120 stroke survivors who were recruited at admission to stroke units in western Sweden and were followed-up at six weeks, three months and one year after stroke event. Repeated assessments were done through face-to-face interviews consisting of a battery of questions based on the Stroke ICF Core Set (59 categories of Body Functions, 59 of Activities and Participation and 37 of Environmental Factors) and several questionnaires (EuroQol-5D (EQ-5D), Stroke Impact Scale (SIS), Medical Outcome Study Short Form 36 (SF-36), Self administered Comorbidity Questionnaire (SCQ), information on health care and social services utilization and spouse support). Study IV was based on data from the multi-center cross-sectional validation study of the Stroke ICF Core Set with 757 stroke survivors from China, Germany, Italy and Sweden. Results. Study I: A total of 28 of 59 ICF categories of Body Functions and a total of 41 of 59 categories of Activities and Participation were significant problems for stroke survivors at six weeks and three months. These categories showed a good discriminative ability to distinguish between independent (≤ 2 on modified Ranking Scale (mRS)) and dependent (> 2 on mRS) stroke survivors. Study II: Most stroke survivors felt satisfied with their stroke care and rehabilitation during three months post-stroke. Frequently perceived environmental facilitators could be documented with eleven of 37 ICF categories of Environmental Factors. Only physical geography, such as hills, was a common perceived barrier. Study III: Independent factors of health-related quality of life (HRQoL) varied over time. Almost all variance in HRQoL was explained by categories within Body Functions and within Activities and Participation during the first three months, while at one year only half of the variance could be explained by categories within either Body Functions or Environmental Factors. Problems with personal and energy functions, as well as limited recreational activities, were recurringly associated with poorer HRQoL. Study IV: It was possible to integrate ICF categories of Body Functions and Structures, Activities and Participation into a cross-cultural measurement with good reliability providing summary scores of the overall functioning of stroke survivors. However, the five-point ICF qualifier scale was not consistently applicable. Conclusions. The results of the present thesis showed that the ICF,particularly the ICF Core Set for Stroke, was a valid and practical tool for documenting the multi-faceted biopsychosocial problems and consequences after stroke structured with one common terminology throughout the long chain of care and rehabilitation. The opportunity to integrate ICF categories of Body Functions and Structures, Activities and Participation into a measurement provides new possibilities for monitoring, following-up and comparing overall functioning after stroke. / Syfte. Avhandlingen i sin helhet syftade till att fastställa de mångfaldiga biopsykosociala konsekvenserna under ett års tid efter stroke med hjälp av ICF och att testa validiteten av det nyetablerade Stroke ICF Core Set med avsikt att mäta funktionstillstånd efter stroke. Material och metod. I studie I, II och III ingår data från en ett års prospektiv kohortstudie med 120 personer med stroke som vårdades på strokeenheter i Västsverige och somföljdes upp efter sex veckor, tre månader och efter ett år. Datainsamlingen genomfördes med intervjuer som bestod av ett batteri av frågor grundat påStroke ICF Core Set, EuroQol-5D (EQ-5D), Stroke Impact Scale (SIS), Medical Outcome Study Short Form 36 (SF-36), Self-administered Comorbidity Questionnaire (SCQ), och information om insatser från hälso- och sjukvård, socialtjänst och familj. I studie I analyserades de 59 ICFkategorierna gällande Kroppsfunktioner och de 59 kategorier gällande Aktivitet och Delaktighet deskriptivt vid sex veckor och tre månader efter stroke. Därutöver prövades core sets förmåga att skilja mellan personer som var antingen beroende eller oberoende av hjälp efter stroke. Hur deltagarna uppfattade omgivningsfaktorernas betydelse analyserades deskriptivt utifrån de 37 ICF kategorierna från Omgivningsfaktorer i studie II vid sex veckoroch tre månader liksom skillnaderna mellan deltagarna som var hemma redan vid sex veckor och deltagarna som kom hem senare men inom tre månader. I studie III identifierades faktorerna av generell hälso-relaterad livskvalitet (EQ-5D visuell analog skala) med hänsyn till den biopsykosociala mångfaldigheten av hälsan och huruvida faktorerna ändrades under ett år efter stroke. Till detta användes korrelation- och regressionsanalys och de 155 ICF kategorier gällande Kroppsfunktioner, Aktivitet och Delaktighet samt Omgivningsfaktorer. Den pyskometriska analysen i studie IV baserades på datamaterial från WHO:s internationella multicentertvärsnittsstudie för validering av Stroke ICF Core Sets där 757 personer med stroke från Kina, Tyskland, Italien och Sverige ingår. Möjligheten att integrera 15 ICF kategorier från Brief ICF Core Set for Stroke (6 kroppsfunktioner, 2 strukturer, 7 aktiviteter och delaktighet) med dess 5-stegsbedömningsskala (från 0 till 4, inget, lätt, måttligt, stort och totalt problem) undersöktes både nationsspecifikt men också tvärkulturellt med Raschanalys. Resultat. Studie I. Signifikanta problem kunde dokumenteras med 28 ICF kategorierfrån komponenten Kroppsfunktion och med 41 ICF kategorier frånkomponenten Aktivitet och Delaktighet. Det fanns inga skillnader mellan 6veckor och 3 månader. Kategorierna hade en god förmåga att skilja mellan personer som var antingen oberoende eller beroende av hjälp efter stroke. Personer som var beroende av hjälp hade kontinuerlig mera problem inom området som gällde framförallt förflyttning, personlig vård och urinering men även kommunikation. Studie II. Deltagarna uppfattade elva omgivningsfaktorer som underlättande vid sex veckor och vid tre månader (framförallt familj, vänner och hälso- ochsjukvårdspersonal men också hjälpmedel, medicin och hälso- och sjukvårdsservice) och endast en faktor (fysisk geografi, dvs. backe, grusvägar, etc.) som hindrande. Vid tre månader uppfattades de sistnämnda faktorerna vanligare som hindrande än vid sex veckor. Vården på strokeenheten upplevdes något bättre jämfört med den senare tillkomna servicen från primär- och kommunvård. Studie III. Medan kroppsfunktioner och aktiviteter och delaktighet kunde förklara nästan all varians av självupplevd hälsa under de första tre månaderna (R2=0.80 - 0.93), så kunde bara hälften av variationen förklaras antingen med kroppsfunktioner eller med omgivningsfaktorer (R2=0.51). Problem med fritidsaktiviteter, personlighet, mental uttröttbarhet ochgångförmåga var återkommande problem som var relaterat till sämre självupplevd hälsa under året efter insjuknandet. Studie IV. Efter justeringar som innebar en minskning av bedömningsskalan till mellan två till tre svarsalternativ för vissa kategorier och en borttagning av några kategorier som inte passade in i Raschmodellen visade de resterande ICF kategorierna en bra täckning av personernas funktionstillstånd efter stroke och en god reliabilitet för att mäta funktionstillstånd. I den tvärkulturella analysen fanns det fyra kategorier sominte hade samma betydelse i de olika länderna. Därför utformades nationsspecifika kategorier. Det slutliga tvärkulturella instrumentet omfattar 20 ICF kategorier. Därmed blir det möjligt att integrera olika ICF kategorier till ett instrument och summera bedömningsvärden av de olika kategorierna till ett helhetsvärde för funktionstillstånd som underlättar uppföljning av och jämförelse mellan personer med stroke men även jämförelse mellan olika nationer. Slutsats. Studierna visar att ICF, och särskilt det specifika Stroke ICF Core Set, är ett valid och praktiskt verktyg för att strukturerat kunna dokumentera de mångfaldiga problemen och konsekvenserna efter stroke enhetlig genom hela förloppet av vårdkedjan. Strokesjukvården i Sverige upplevs som välfungerande men en god förbättringspotential finns framförallt i senare skede när primär- och kommunvård ta över ansvaret för personernas vård och rehabilitering. För dokumentation av funktionstillstånd av den typiska äldre patienten med stroke kan de 166 ICF kategorierna reduceras till 92. Faktorer som påverkar hälsorelaterad livskvalitet varierar under tiden efter insjuknandet där kroppsfunktioner och aktiviteter och delaktighet är starkt relaterade under de första tre månaderna. Vid ett år efter insjuknandet har omgivningens betydelse ökat för hälsorelaterad livskvalitet. Tidig hänsyn inte bara till gångförmåga men också till problem med personlighet och temperament, mental uttröttbarhet och återgång till fritidsaktiviteter borde kunna förbättra personernas livskvalitet efter stroke. Att konstruera ett tvärkulturellt instrument i syfte att mäta funktionstillstånd efter stroke genom integrering av ICF kategorier som omfattar kroppsfunktioner, strukturer, och aktiviteter och delaktighet är möjligt. Därmed öppnas nya potentialer för att kunna följa upp och jämföra funktionstillstånd efter stroke inte enbart på individ- och nationell nivå men även på populations- och internationell nivå. Den 5-stegs bedömningsskala (ICF qualifier) är dock inte psykometrisk användbart och fortsatt forskning behövs.

Information Systems (IS) research frequently uses survey data to measure the interplay between technological systems and human beings. Researchers have developed sophisticated procedures to build and validate multi-item scales that measure real world phenomena (latent constructs). Most studies use the so-called classical test theory (CTT), which suffers from several shortcomings. We first compare CTT to Item Response Theory (IRT) and subsequently apply a Rasch model approach to measure hedonic aspects of websites. The results not only show which attributes are best suited for scaling hedonic information systems, but also introduce IRT as a viable substitute that overcomes severall shortcomings of CTT. (author´s abstract) / Series: Research Report Series / Department of Statistics and Mathematics

This study aims to develop assessment which measures learning progressions for important scientific concepts such as oxidation-reduction (redox) and to identify students¡¦ zone of proximal development (ZPD) through teaching practice incorporating assessment feedback. The assessment items of redox were developed based on the framework of the BEAR (Berkeley Evaluation and Assessment Research) Assessment System. Six experts from chemistry, science education, and educational assessment, and three high school chemistry teachers with fruitful instructional experiences were recruited into the assessment team. Through 24 panel discussions, 28 ordered multiple-choice items were developed. Two samples of Taiwanese middle-school students participated in the test development: one for item revision and the other for validation. Sample 1 and 2 consisted of 626 middle school students (304 8th graders and 322 9th graders) and 903 9th graders, respectively. The materials for instruction integrated assessment feedback were designed by the researcher and two middle-school science teachers through seven group meetings. A teaching experiment was implemented to examine the effect of assessment feedback on students¡¦ understandings of redox and to identify their ZPD. The teaching experiment employed a quasi-experiment with a non-equivalent-group pretest-posttest design. Participants were 196 eighth graders (101 boys and 95 girls) from three middle schools. The findings showed that (a) the BEAR assessment system and Rasch measurement approaches provided a feasible framework for developing validated tools to assess learning progressions; (b) the empirical data supported students¡¦ learning of redox concept usually progressed ¡§from uni-structure to multi-structure¡¨ and ¡§from discrete sub-concepts to integrated concepts¡¨; (c) the teaching practice integrated assessment feedback effectively facilitated students¡¦ understanding of scientific concepts; (d) the assessment of learning progressions provided a mechanism for identifying students¡¦ ZPD and helped realize the abtract idea of ZPD in teaching practices. The main contributions of the study included (a) demostrating how to carry out the idea of ZPD into teaching practices through linking learning progressions and ZPD; (b) presenting how to apply BEAR assessment system and Rasch techniques to develop tools for assessing learning progressions; (c) developing a set of items for assessing learning progressions of redox and a series of materials for teaching practices integrated assessment feedback.

<p>The overall aim of this thesis was to examine the construct validity and the reliability of the instrument DOA; Dialogue about working ability. The theoretical foundation for DOA is the Model of Human Occupation. The instrument is divided into two sections; client self-assessment and professional assessment focusing on the individual’s working ability. The assessments are followed by a dialogue to distinguish goals for the return to-work process based on the client’s own preferences. In line with the theoretical base, the concept ‘work’ refers to both paid work and other productive activities related to work.</p><p>In Study I, 21 professionals and 126 clients participated from three clinics in Sweden. All clients were involved as outpatients in psychiatric work rehabilitation in county councils or community services. The results from the Rasch analysis test indicated that items are well separated from each other and generally work together in five unidimensional continuums with the objective to measure abilities related to work. Twenty-nine of 34 items showed goodness-of-fit statistics, which means acceptable infit MnSq values from >0.6 to <1.4 in association with Z values from –2 to 2, and that the five misfit items have to be revised.</p><p>Thirty-four outpatient clients and 14 professionals from four clinics within psychiatric work rehabilitation in Sweden participated in Study II. Two reliability aspects were studied: test-retest and inter rater reliability. The statistical analyses used were Spearman Rank Correlation test and Percentage of agreement (PA). Generally, the Spearman Rank Correlation test showed acceptable significant correlations between test retest since a greater part of items correlated “moderate to good” (r = 0.51 – 0.75). In the inter raters´ test PA was good, ranging from 93.1 % to 96.5 %, which is well above the acceptable criteria of 80 %. There were no significance differences between the raters. The study has shown that one item has to revised.</p><p>The findings verify that DOA has potential as a means of making valid and reliable assessments of working ability, as described by the Model of Human Occupation, out of both clients´ and occupational therapists´ perspective.</p>

The purpose of this paper is to generalize regression models for repeated categorical data based on maximizing a conditional likelihood. Some existing methods, such as those proposed by Duncan (1985), Fischer (1989), and Agresti (1993, and 1997) are special cases of this latent variable approach, used to account for dependencies in clustered observations. The generalization concerns the incorporation of rather general data structures such as subject-specific time-dependent covariates, a variable number of observations per subject and time periods of arbitrary length in order to evaluate treatment effects on a categorical response variable via a linear parameterization. The response may be polytomous, ordinal or dichotomous. The main tool is the log-linear representation of appropriately parameterized Rasch-type models, which can be fitted using standard software, e.g., R. The proposed method is applied to data from a psychiatric study on the evaluation of psychobiological variables in the therapy of depression. The effects of plasma levels of the antidepressant drug Clomipramine and neuroendocrinological variables on the presence or absence of anxiety symptoms in 45 female patients are analyzed. The individual measurements of the time dependent variables were recorded on 2 to 11 occasions. The findings show that certain combinations of the variables investigated are favorable for the treatment outcome. (author´s abstract) / Series: Research Report Series / Department of Statistics and Mathematics

Le modèle de Rasch est utilisé de nos jours dans de nombreuses applications en sciences sociales et en médecine. Parmi les applications de ce modèle, on trouve l’étude de la qualité psychométrique des items d’un test, le calibrage des items pour les tests adaptatifs, la production des mesures d’habileté en sciences de l’éducation. Il est particulièrement mis à profit dans des enquêtes internationales à grande échelle comme l’enquête PISA (Programme for International Student Assessment). L’une des hypothèses que doivent vérifier l’ensemble des items du test devant mesurer un trait donné est celle de l’unidimensionnalité, c’est-à dire que tous mis ensemble ne doivent mesurer que le trait en étude, et la réponse que donne un individu à chacun de ces items n’est fonction que du niveau de ce trait chez cet individu. Il se pose donc l’épineuse question de la détermination de la dimensionnalité de l’outil de mesure, car l’objectif étant de ne conserver ensemble que des items concourant à mesurer un seul et même trait. En pratique, les tests auxquels sont soumis les individus ne sont pas strictement unidimensionnels car nos réponses sont aussi conditionnées par nos habitudes et notre milieu. Le plus important selon Stout (1987) est d’avoir un test ayant une dimension dominante, car sinon on devra utiliser des modèles multidimensionnels qui s’avèrent souvent complexes et difficiles à interpréter pour un preneur de décision non expert en mesure. Notre travail a consisté à explorer un ensemble de conditions dans lesquelles le modèle de Rasch unidimensionnel peut produire des mesures acceptables malgré la présence de plusieurs traits déterminants dans les données. Nous avons travaillé avec des données bidimensionnelles simulées, et avons mis à profit le modèle linéaire multiple et les statistiques d’ajustement infit t du modèle de Rasch unidimensionnel. / Today, the Rasch model is most used in many applications of the social sciences and in medicine. Among the applications of this model, one can cite the study of the psychometric qualities of test items, items calibration in adaptive testing and the production of skill measures in education science. It is particularly used in international large-scale surveys such as PISA (Programme for International Student Assessment) survey. One of the assumptions test items selected to measure a given trait must satisfied is the unidimensionality assumption, that is all items put together should measure the trait under study, and the response given by an individual to each of these items is a function only of the level of the trait that the individual possesses. This raises the issue of determining the dimensionality of a measurement tool, because the goal is to keep only items that contribute to measure the single trait. In practice, not all test instruments developed to collect data from individuals are strictly unidimensional because our responses are also influenced by our habits and our environment. According to Stout (1987) the most important thing is to have a test with a dominant dimension, otherwise we will use multivariate models that are often complex and difficult to interpret for a decision maker who is not an expert in measurement theory. Our work has been to explore a set of conditions under which the Rasch model can produce acceptable measures despite the presence of several dimensions in the data. We worked with two-dimensional simulated data and have used the multiple linear regression model and infit statistics t produced by the unidimensional Rasch model. / Le logiciel de simulation des données et d'analyse est Conquest V.3

Intercollegiate athletics in the United States have continuously become more commercialized, pressuring athletics departments and coaches to produce winning teams. The commanding expectations for successful programs have been thought to take away from the academic mission of colleges and universities, focusing efforts on athletics over academics. This phenomenon has been examined, but the role head coaches play in support of student-athlete academics has yet to be explored. The purpose of this study is to measure student-athlete perception of academic support from Division I head coaches. Current literature demonstrates the strong influence of coaches on student-athletes, but the effect in the area of academics is unknown. Therefore, the research presented aims to evaluate the connection between student-athletes and the academic support of head coaches.