Development of a new Rasch-based scoring algorithm for the National Eye Institute Visual Functioning Questionnaire to improve its interpretability

Jennifer Petrillo, Neil M Bressler, Ecosse Lamoureux, Alberto Ferreira, Stefan Cano

Research output: Contribution to journalArticle

Abstract

Background: The NEI VFQ-25 has undergone psychometric evaluation in patients with varying ocular conditions and the general population. However, important limitations which may affect the interpretation of clinical trial results have been previously identified, such as concerns with reliability and validity. The purpose of this study was to evaluate the National Eye Institute Visual Functioning Questionnaire (NEI VFQ25) and make recommendations for a revised scoring structure, with a view to improving its psychometric performance and interpretability. Methods: Rasch Measurement Theory analyses were conducted in two stages using pooled baseline NEI VFQ25 data for 2487 participants with retinal diseases enrolled in six clinical trials. In stage 1, we examined: scale-to-sample targeting; thresholds for item response options; item fit statistics; stability; local dependence; and reliability. In stage 2, a post-hoc revision of the scoring structure (VFQ-28R) was created and psychometrically re-evaluated. Results: In stage 1, we found that the NEI VFQ25 was mis-targeted to the sample, and had disordered response thresholds (15/25 items) and mis-fitting items (8/25 items). However, items appeared to be stable (differential item functioning for three items), have minimal item dependency (one pair of items) and good reliability (person-separation index, 0.93). In stage 2, the modified Rasch-scored NEI VFQ28R was assessed. It comprised two broad domains: Activity Limitation (19 items) and Socio-Emotional Functioning (nine items). The NEI VFQ28R demonstrated improved performance with fewer disordered response thresholds (no items), less item misfit (three items) and improved population targeting (reduced ceiling effect) compared with the NEI VFQ25. Conclusions: Compared with the original version, the proposed NEI VFQ28R, with Rasch-based scoring and a two-domain structure, appears to offer improved psychometric performance and interpretability of the vision-related quality of life scale for the population analysed.

Original languageEnglish (US)
Article number157
JournalHealth and Quality of Life Outcomes
Volume15
Issue number1
DOIs
StatePublished - Aug 14 2017

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National Eye Institute (U.S.)
Psychometrics
Clinical Trials
Population
Retinal Diseases
Reproducibility of Results
Quality of Life
Surveys and Questionnaires

Keywords

  • National Eye Institute Visual Functioning Questionnaire
  • Rasch Measurement Theory
  • Vision-related quality of life

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Development of a new Rasch-based scoring algorithm for the National Eye Institute Visual Functioning Questionnaire to improve its interpretability. / Petrillo, Jennifer; Bressler, Neil M; Lamoureux, Ecosse; Ferreira, Alberto; Cano, Stefan.

In: Health and Quality of Life Outcomes, Vol. 15, No. 1, 157, 14.08.2017.

Research output: Contribution to journalArticle

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