Affiliations: [a] College of Medical and Dental Sciences, University of Birmingham, UK | [b] Department of Neuropsychiatry, The Barberry, Birmingham, UK | [c] Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK | [d] Faculty of Medicine and Human Sciences, Institute of Human Development, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
Correspondence:
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Correspondence to: George McNally, Brooke House, 16 Church St, Braunston, Rutland, LE15 8QT, UK. Tel.: +44 07742089855; E-mail: [email protected].
Abstract: Background:The short version of the Problem Behaviours Assessment (PBA-s) is the recommended outcome measure for behavioural symptoms in Huntington’s disease. Rasch analysis was used to further investigate the measurement limitations of the PBA-s. Objectives:1) To assess the psychometric properties of the 11 severity and frequency items within the PBA-s and 2) to determine the construct validity of using a total PBA-s score as a clinical outcome measure. Methods:PBA-s data for 517 participants from Enroll-HD were included in the Rasch analysis. Separate analyses were conducted for the severity and frequency items of the PBA-s, using RUMM2030 software. Achieving fit to the model provides supporting evidence that all items contribute to a single underlying latent trait. This property is defined as internal construct validity. Results:The total PBA-s severity score demonstrated several important limitations, including disordered response categories for all 11 severity items, local dependency and poor targeting. However, modifying the original five-point scoring system to a four-point system resulted in ordered response categories for seven of the severity items and achieved a good overall fit to the Rasch model. For the total PBA-s frequency score, fit to the model was not achieved even after amendments to the scoring system. Conclusions:This study suggests that with reduction to a four-point scoring system, the total PBA-s severity score may be considered a valid clinical outcome measure. This study also suggests limitations in the use of a total PBA-s frequency score.
Keywords: Rasch, psychometrics, Huntington’s disease, Problem Behaviours Assessment, Enroll-HD
