Data di Pubblicazione:
2004
Citazione:
Bio-medicine and the Rehabilitation Scientific Model : Rasch Measurement / L. Tesio. ((Intervento presentato al 15. convegno Israel Medical week tenutosi a Tel Aviv nel 2004.
Abstract:
“Hard” sciences based on “objective” measurements such as chemistry and physics provide the backbone of Bio-medicine. This explores and strives to repair body parts (ranging from organs to molecules) “from inside”. “Whole-person” phenomena (behaviours) such as walking, speaking, suffering pain, being dependent on another one’s help cannot be ascribed to any parts of the person. Behaviours can only be observed “from outside”. Raters can only approach at large a linear continuous measure by assigning “subjective” discontinuous scores (yes/no, 0/1) to items/questions in questionnaires. Questionnaires are the basis for measurement in “soft” sciences” such as Psychology and Sociology. Is Rehabilitation outside the mainstream of bio-medical research?
Behavioural outcomes are the core business of Rehabilitation which, in fact, used massively the questionnaires.
In the meanwhile, Rehabilitation is deeply rooted within biomedical sciences. It tended to consider questionnaires as a secondary issue, not worth of any specific scientific efforts.
The statistical model proposed in 1960 by Georg Rasch (died 1980) provided a formal and general solution to most of the weaknesses of raw scores.
Since 1989, Rasch modelling was more and more adopted in Rehabilitation: a) to re-validate and improve existing questionnaires (e.g. Functional Independence Measure and Dizziness Handicap Inventory); b) to build up new questionnaires focussed on established variables (e.g. EquiScale for balance); c) to outline new variables (e.g. BACKILL for back syndromes; LAPMER for disability in profound mental retardation; ABILHAND for manual ability in Stroke and Rheumatoid Arthritis; SCIM for disability in spinal lesions; Work Instability Scale for unemployment risk in disabled people); e) to equate questionnaires tackling the same construct across different languages and cultures (e.g. the PRO-ESOR european study); f) to build-up quality checks of outcome measures adopted for financial and management purposes (e.g. the FIM-based inpatient classification system in Italy).
Indeed, Rasch analysis is now reinforcing the “soft” side of Rehabilitation research.
References:
• Andrich D. ‘Rasch models for measurement.’ 1998. Sage Publications, Newbury Park.
• Gray ML, Bonventre JV. Training PhD researchers to translate science to clinical medicine: closing the gap from the other side. Nature Medicine 2002;8:433-43.
• Kuhn TS. The structure of scientific revolution. The University of Chicago Press 1970 (original edition 1962).
• Tesio L. Measuring person’s behaviours and perceptions: Rasch analysis as a tool for rehabilitation research. Journal of Rehabilitation Medicine 2003;35:105-115.
• Tesio L. Measurement in clinical vs. biological medicine. The Rasch model as a bridge over a widening gap. J Appl Meas 2004, submitted.
• Wright B, Linacre JM. Observations are always ordinal: measurement, however, must be interval. Arch Phys Med Rehabil 1989;70,12:857-860
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
L. Tesio
Link alla scheda completa: