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Session Title: Special Cases
Session Date/Time: Monday 07/10/2013 | 17:00-18:30
Paper Time: 17:27
Venue: Elicium 1 (First Floor)
First Author: : K.Pesudovs AUSTRALIA
Co Author(s): : J. Khadka E. Fenwick E. Lamoureux
Over 100 questionnaires have been developed in ophthalmology, almost all of which are traditional paper and pencil based. These instruments are burdensome to administer and limited by a lack of comparability of scores across studies and diseases. Moreover, these instruments are outdated in item content and lack content suitability across different populations. A superior strategy would be to use computer-adaptive testing (CAT) in which Rasch calibrated items from an item bank (a large number of items pooled across different domains of QOL) are presented based on a patients response to previous items and so item difficulty can be tailored to an individuals ability. Thus, the item banking and CAT provide rapid, precise and accurate and comprehensive assessment of QOL impact. Therefore, we are currently developing such item banks (the Eye-tem Bank project) in ophthalmology. The Eye-tem Bank project aims to develop and validate item banks implemented via computer adaptive testing system to enable measurement of ophthalmic quality of life (QOL) for all eye diseases across all populations. Here, we present an update of the Eye-tem Bank project.
Discipline of Optometry and Vision Science, Flinders University, South Australia, Australia; Royal Adelaide Hospital, South Australia, Australia; The Queen Elizabeth Hospital, South Australia, Australia; The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
Ten QOL domains important to ophthalmic patients were initially identified. These domains are: activity limitation, mobility, visual symptoms, ocular surface symptoms, general symptoms, emotional well-being, health concerns, convenience, social well-being and economic impact. These 10 QOL domains are being assimilated into the 11 targeted disease-specific Eye-tem Bank modules: cataract, corneal diseases, glaucoma, diabetic retinopathy (DR), age-related macular degeneration (AMD), other vitreo-retinal, refractive error, amblyopia & strabismus, external eye diseases, inflammation and neuro-ophthalmic. Each disease group module is undergoing a four-phase development process: Phase I: Content identification (items from existing PRO instruments and disease-specific patient focus groups); Phase II: Pilot testing the initial item sets to test psychometric properties (a set of tests to show how good an instrument is at measuring an underlying QOL construct) and for item calibration to develop CAT system using Rasch analysis; Phase III: Validation of Eye-tem Bank implemented via a CAT system; and Phase IV: Evaluating ophthalmic QOL using the Eye-tem Bank.
Phase II of the Glaucoma (n=293; male, 55%; median age, 70 yrs; range 20-91 yrs) and the DR (n=466; male, 69% male; median age, 62 yrs; range 22-88 yrs) modules have been completed. In the Glaucoma group, the majority (between 80% and 93%) of the participants endorsed the two lower end categories of all items, indicating that most participants had low levels of QOL impact across the domains. Rasch analysis of both the Glaucoma and DR modules showed that only 27 (7.9%) and 28 (8.9%) of the items were misfitting, respectively. Moreover, all the disease-specific QOL domains of these two modules demonstrated good psychometric properties against most Rasch-based metrics. Several disease-specific phase I patient focus groups and phone interviews have been completed (AMD group; n=40 recruits; completed, 2 focus groups and 7 phone interviews and other vitreo-retinal groups; n=39 recruits; completed 5 phone interviews). More focus groups and interviews are being organised for these two disease areas. Phase I patient recruitment for other disease-specific Eye-tem Bank modules is ongoing.
The 342-item Glaucoma and 314-item DR modules of the Eye-tem bank showed promising psychometric properties when analysed using Rasch analysis. These items are being calibrated to develop the CAT based systems for the Glaucoma and DR modules for further validation and reliability tests. All the other disease-specific modules of the Eye-tem Bank project will also follow the same development steps and a series of validation and reliability tests to develop an internet-based CAT system to enable a comprehensive measurement of QOL in all eye diseases worldwide.
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