Document Detail

Cross-cultural differences in knee functional status outcomes in a polyglot society represented true disparities not biased by differential item functioning.
MedLine Citation:
PMID:  20947673     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Comparative effectiveness research across cultures requires unbiased measures that accurately detect clinical differences between patient groups.
OBJECTIVE: The purpose of this study was to assess the presence and impact of differential item functioning (DIF) in knee functional status (FS) items administered using computerized adaptive testing (CAT) as a possible cause for observed differences in outcomes between 2 cultural patient groups in a polyglot society.
DESIGN: This study was a secondary analysis of prospectively collected data.
METHODS: We evaluated data from 9,134 patients with knee impairments from outpatient physical therapy clinics in Israel. Items were analyzed for DIF related to sex, age, symptom acuity, surgical history, exercise history, and language used to complete the functional survey (Hebrew versus Russian).
RESULTS: Several items exhibited DIF, but unadjusted FS estimates and FS estimates that accounted for DIF were essentially equal (intraclass correlation coefficient [2,1]>.999). No individual patient had a difference between unadjusted and adjusted FS estimates as large as the median standard error of the unadjusted estimates. Differences between groups defined by any of the covariates considered were essentially unchanged when using adjusted instead of unadjusted FS estimates. The greatest group-level impact was <0.3% of 1 standard deviation of the unadjusted FS estimates.
LIMITATIONS: Complete data where patients answered all items in the scale would have been preferred for DIF analysis, but only CAT data were available.
CONCLUSIONS: Differences in FS outcomes between groups of patients with knee impairments who answered the knee CAT in Hebrew or Russian in Israel most likely reflected true differences that may reflect societal disparities in this health outcome.
Daniel Deutscher; Dennis L Hart; Paul K Crane; Ruth Dickstein
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-10-14
Journal Detail:
Title:  Physical therapy     Volume:  90     ISSN:  1538-6724     ISO Abbreviation:  Phys Ther     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-02     Completed Date:  2011-01-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0022623     Medline TA:  Phys Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1730-42     Citation Subset:  AIM; IM    
Physical Therapy Service, Maccabi Healthcare Services, 27 Hamered St, Tel Aviv, Israel.
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MeSH Terms
Activities of Daily Living
Chi-Square Distribution
Cross-Cultural Comparison*
Diagnosis, Computer-Assisted
Disability Evaluation
Israel / ethnology
Knee Injuries / diagnosis*,  ethnology,  physiopathology*
Knee Joint / physiopathology*
Middle Aged
Prospective Studies
Russia / ethnology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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