Cross-diagnostic validity of the SF-36 physical functioning scale in patients with stroke, multiple sclerosis and amyotrophic lateral sclerosis: A study using Rasch analysis

Annet J. Dallmeijer, Vincent de Groot, Leo D. Roorda, Vera P.M. Schepers, Eline Lindeman, Leonard H. van den Berg, Anita Beelen, Joost Dekker, G. J. Lankhorst, M. J. IJzerman, H. Beckerman, A. J. Prevo, H. J. Stam, E. Odding, B. van Baalen

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Objective: The aim of this study was to investigate unidimensionality and differential item functioning of the SF-36 physical functioning scale (PF10) in patients with various neurological disorders. Patients: Patients post-stroke (n = 198), with multiple sclerosis (n = 151) and amyotrophic lateral sclerosis (n = 193) participated. Methods: Unidimensionality of the PF10 within the patient groups was investigated by performing a separate Rasch analysis for each group. Differential item functioning was investigated in a pooled Rasch analysis of the 3 groups. Results: Within each group, all items fitted the Rasch model, except the "bathing/dressing" item in the amyotrophic lateral sclerosis group. The pooled analysis showed inadequate fit to the Rasch model for one item ("walking several hundred metres"). Of the other 9 fitting items, 5 showed differential item functioning for stroke vs multiple sclerosis and amyotrophic lateral sclerosis, while no differential item functioning was found between multiple sclerosis and amyotrophic lateral sclerosis. Conclusion: All items of the PF10, except one for the amyotrophic lateral sclerosis group, form a unidimensional scale, supporting the use of a sum score as a measure of physical functioning within these diagnostic groups. When comparing the data of patients after stroke, with that of patients with multiple sclerosis and/or amyotrophic lateral sclerosis patients, adjustments for differential item functioning are required.

Original languageEnglish
Pages (from-to)163-169
Number of pages7
JournalJournal of rehabilitation medicine
Issue number2
Publication statusPublished - 1 Mar 2007


  • Amyotrophic lateral sclerosis
  • Cross-diagnostic validity
  • Differential item functioning
  • Multiple sclerosis
  • Physical functioning
  • Rasch model
  • Stroke

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