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Development and Psychometric Evaluation of a Fatigability Index for Full-Time Wheelchair Users With Spinal Cord Injury

  • Alina Ionela Palimaru
    Correspondence
    Corresponding author Alina Ionela Palimaru, PhD, MPP, Fielding School of Public Health, Department of Health Policy and Management, UCLA, 640 Charles E. Young Dr. S, CHS 3rd floor, Los Angeles, CA 90095.
    Affiliations
    Department of Health Policy and Management, Fielding School of Public Health, The University of California, Los Angeles (UCLA), Los Angeles, California, United States
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  • William E. Cunningham
    Affiliations
    Department of Health Policy and Management, Fielding School of Public Health, The University of California, Los Angeles (UCLA), Los Angeles, California, United States

    Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, UCLA, Los Angeles, California, United States
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  • Marcus Dillistone
    Affiliations
    Royal Society of Medicine, Marylebone, London, United Kingdom
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  • Arturo Vargas-Bustamante
    Affiliations
    Department of Health Policy and Management, Fielding School of Public Health, The University of California, Los Angeles (UCLA), Los Angeles, California, United States
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  • Honghu Liu
    Affiliations
    Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, UCLA, Los Angeles, California, United States

    Division of Public Health and Community Dentistry, School of Dentistry, UCLA, Los Angeles, California, United States

    Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, California, United States
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  • Ron D. Hays
    Affiliations
    Department of Health Policy and Management, Fielding School of Public Health, The University of California, Los Angeles (UCLA), Los Angeles, California, United States

    Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, UCLA, Los Angeles, California, United States
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Published:April 25, 2018DOI:https://doi.org/10.1016/j.apmr.2018.04.003

      Abstract

      Objective

      To develop and evaluate psychometrically a self-reported instrument assessing physical fatigability (PF) and mental fatigability (MF) in adults with spinal cord injury (SCI).

      Design

      Cross-sectional.

      Setting

      Peer-support groups at rehabilitation centers, online support groups.

      Participants

      Adults with SCI (N=464) in the United States.

      Interventions

      Not applicable.

      Main Outcome Measures

      The dimensional structure was assessed by confirmatory factor analysis. The relationship between item responses and fatigability was measured with item response theory (graded response model). Reliability was measured with test information functions. Differential item functioning was evaluated with Wald chi-square tests and the weighted area between the curves. Construct validity was assessed using the known groups method.

      Results

      An 82-item pool was developed from prior qualitative research and consultations with rehabilitation experts. A non-probability sample (N=464) was used to evaluate the psychometric properties of the PF and MF scales. The item pool was reduced to 75 based on factor loadings and R2. Both scales are primarily unidimensional, despite moderate multidimensionality. There is good discrimination overall: 18 PF items and 26 MF items have high or very high discrimination power (slopes > 1.35). The measurement precision in the theta range -2.0 to 2.5 is the equivalent of 0.94 reliability for PF and 0.91 for MF. For both measures, F statistics P values were significant at P<.01, and means were higher for those with paraplegia vs quadriplegia, and for those with incomplete paraplegia.

      Conclusions

      The Fatigability Index is the first instrument designed to assess physical and mental fatigability in adults with SCI. The index highlights causes of fatigue and areas requiring immediate intervention. Development of short-forms and further research on representative samples are necessary.

      Keywords

      List of abbreviations:

      SCI (spinal cord injury), PF (physical fatigability), MF (mental fatigability), CFA (confirmatory factor analysis), IRT (item response theory), DIF (differential item functioning), wABC (weighted area between the curves), RMSEA (Root Mean Square Error of Approximation), CFI (Comparative Fit Index), TLI (Tucker-Lewis Index), PUC (percent uncontaminated correlations), ECVGEN (explained common variance on the general dimension), I-ECV (individual explained common variance)
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