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David A Leske, Sarah R Hatt, Laura Liebermann, Jonathan M Holmes; Comparison of Rasch Methods for Responsiveness Analysis of the Adult Strabismus 20 Questionnaire. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4088. doi: https://doi.org/.
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The Adult Strabismus 20 (AS-20) Questionnaire is a validated strabismus-specific health-related quality of life (HRQOL) instrument. Rasch analysis provides a linear measure of HRQOL, and for ease of use in the ophthalmic community, we have previously provided Rasch lookup tables online. We compared responsiveness of the AS-20 to surgical intervention when raw scores are converted to a Rasch measure using the lookup table vs a more rigorous method of performing a de novo stacked Rasch analysis.
147 adult strabismus patients completed the AS-20 before surgery and again at their 6-week postoperative visit (median 7 weeks, range 4-21 weeks). AS-20 scores were analyzed using 2 methods 1) using Rasch lookup tables 2) using a de novo stacked Rasch analysis. Pre- and postoperative scores were compared for each of the 4 AS-20 domains (Self-Perception, Interactions, Reading Function, and General Function) by comparing distributions (signed-rank), effect sizes, and the proportion of subjects exceeding 95% limits of agreement (LOA) derived from a previous test-retest study (McNemar’s).
Significant improvement was observed for all 4 AS-20 domains using lookup methods and stacked analysis (P<0.0001 for all comparisons). Effect sizes were comparable whether obtained using lookup tables or stacked analysis for all 4 AS-20 domains (0.60 vs 0.60 respectively for Self-Perception, 0.46 vs 0.51 for Interactions, 0.66 vs 0.72 for Reading Function, and 0.93 vs 0.88 for General Function). A higher proportion of subjects exceeded 95% LOAs using the lookup table vs stacked analysis for Interaction (30% vs 22%, P=0.02), Reading Function (39% vs 25%, P<0.0001), and General Function domains (39% vs 33%, P=0.04).
Similar effect sizes with each method supports using lookup tables to represent patient domain scores. An advantage of using lookup tables is the ability to quantify true change of a single patient using LOAs, which we found problematic when using a stacked analysis due to the open-ended nature of the logit scale. Using the AS-20 Rasch lookup table is a reasonable approach to analyzing response of the AS-20 to an intervention for adult strabismus and may avoid the need to perform a more rigorous de novo stacked Rasch analysis for every study, under the assumption that the population doesn’t markedly differ from that used to create the lookup table.
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