The Foot Posture Index: Rasch Analysis of a Novel, Foot-Specific Outcome Measure
Presented in part to Health Outcomes 2005: Making a Difference, August 17–18, 2005, Canberra, Australia, and the British Society for Rheumatology, May 17–18, 2006, Glasgow, Scotland.
Abstract
Keenan A-M, Redmond AC, Horton M, Conaghan PG, Tennant A. The Foot Posture Index: Rasch analysis of a novel, foot-specific outcome measure.
Objective
To investigate the internal construct validity of a clinician-assessed measure of foot position, the Foot Posture Index (FPI), versions FPI-8 and FPI-6.
Design
Rasch analysis of baseline FPI scores from studies conducted during the development of the instrument.
Setting
A community-based and a hospital-based study, conducted at 2 institutions.
Participants
Measures were obtained from 143 participants (98 men, 45 women; age range, 8–65y).
Interventions
Not applicable.
Main Outcome Measures
Rasch analysis was undertaken using RUMM2020 software in order to evaluate the following properties of the FPI: unidimensionality of each item included in the FPI, the differential item functioning (DIF) of each item, and item and person separation indices.
Results
In the developmental draft of the instrument, the 8-item FPI-8 showed some misfit to the Rasch model (χ162 test=27.63, P=.03), indicating lack of unidimensionality. Two items were identified as problematic in the Rasch modeling: Achilles’ tendon insertion (Helbing’s sign), which showed illogical response ordering and “congruence of the lateral border of the foot,” which showed misfit, indicating that this item may be measuring a different construct (χ22 test=15.35, P<.01). All FPI-8 items showed an absence of DIF, and the person separation index (PSI) was good (PSI=.88). The revised FPI-6, which does not include the 2 problematic items, showed unidimensionality (χ122 test=11.49, P=.49), indicating a good overall fit to the model, and improvement over the preliminary version. With the removal of the 2 problematic items, there were no disordered thresholds; all items remained DIF free and all individual items displayed a good fit to the model. The person-separation index for the FPI was similar for both the 8-item (FPI-8=.880) and 6-item (FPI-6=.884) versions.
Conclusions
The original FPI-8 showed significant mismatching to the model. The 2 items in the FPI-8 that were identified as problematic in clinical validation studies were also found to be contributing to the lack of fit to the Rasch model. The finalized 6-item instrument showed good metric properties, including good individual item fit and good overall fit to the model, along with a lack of differential item functioning. This analysis provides further evidence for the validity of the FPI-6 as a clinical instrument for use in screening studies and shows that it has the potential to be analyzed using parametric strategies.
Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK.
Reprint requests to Anne-Maree Keenan, MAppSc, Academic Unit of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Chapeltown Rd, Leeds, LS7 4SA, United Kingdom
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
ABSTRACT