{"id":622,"date":"2015-08-17T10:54:03","date_gmt":"2015-08-17T10:54:03","guid":{"rendered":"http:\/\/assignmenttask.com\/tutorhelp\/?p=622"},"modified":"2022-10-13T04:55:58","modified_gmt":"2022-10-13T04:55:58","slug":"further-development-of-the-high-level-mobility-assessment-tool","status":"publish","type":"post","link":"https:\/\/assignmenttask.com\/tutorhelp\/further-development-of-the-high-level-mobility-assessment-tool\/","title":{"rendered":"Further Development Of The High-level Mobility Assessment Tool"},"content":{"rendered":"

\"Assignment<\/a><\/p>\n

ORIGINAL ARTICLE
\nFurther development of the High-level Mobility Assessment Tool
\n(HiMAT)
\nGAVIN WILLIAMS1,2, JULIE PALLANT3, & KEN GREENWOOD4
\n1Epworth Hospital, Melbourne, Australia, 2School of Physiotherapy, 3School of Rural Health, University of Melbourne,
\nAustralia, and 4School of Health Sciences, RMIT University, Melbourne, Australia
\n(Received 17 December 2009; accepted 27 April 2010)
\nAbstract
\nPrimary objectives: The high-level mobility assessment tool (HiMAT) was developed to measure high-level mobility
\nlimitations following traumatic brain injury (TBI). Rasch analysis was used in the development to ensure cognitive deficits
\nwould have a minimal impact on performance. The main aim of this study was to investigate the dimensionality of the
\nHiMAT using recently developed advanced testing procedures.
\nResearch design: Results from the original sample of 103 adults with TBI used to develop the HiMAT were re-analysed using
\nthe RUMM2020 program. Revised minimal detectable change (MDC95) scores were also calculated.
\nMain outcomes and results: Rasch analysis of all 13 HiMAT items suggested that the scale was multidimensional, showing
\na clear separation between the stair and non-stair items. The nine non-stair items of the HiMAT showed good overall fit,
\nexcellent internal consistency, with no disordered thresholds or misfitting items, however removal of one item was required
\nto ensure a unidimensional scale. The final 8-item solution showed good model fit (p\u00bc0.93), excellent internal consistency
\n(PSI\u00bc0.96), no disordered thresholds, no misfitting items and no differential item functioning for age or sex. The revised
\nHiMAT total score is 32 points and the MDC95 was calculated to be \u00022 points.
\nConclusion: The results of this study demonstrate that the revised HiMAT is unidimensional and valid to use in
\nrehabilitation and community settings where there is no access to stairs.
\nKeywords: Brain injuries, rehabilitation, gait disorders, neurologic, outcome assessment
\nIntroduction
\nThe high-level mobility assessment tool (HiMAT)
\nwas originally developed to quantify the high-level
\nmobility limitations of people with traumatic brain
\ninjury (TBI) [1, 2]. A key priority in the development
\nof the HiMAT was to ensure that only the
\nphysical component of high-level mobility was
\nquantified. This priority was instrumental in ensuring
\ncognitive deficits would have a minimal impact
\non performance. Rasch analysis was used in the
\ndevelopmental stages to ensure the unidimensionality
\nof the HiMAT items [2]. Recent advances in
\nRasch analysis have indicated that further
\ninvestigation is required using the more advanced
\napproaches currently available to investigate dimensionality
\n[3]. Therefore, the main aim of this study
\nwas to investigate the dimensionality of the HiMAT
\nusing the recently developed advanced testing
\nprocedures.
\nA second priority in the development of the
\nHiMAT was clinical utility. In order to facilitate
\nthe uptake of the HiMAT into a wide range of
\nclinical and community settings, only items which
\nwere minimally dependant on time, equipment and
\nresources were considered. Similar to many mobility
\nscales used in rehabilitation [4\u20139], the HiMAT also
\nCorrespondence: Dr Gavin Williams, Physiotherapy Department, Epworth Hospital, 89 Bridge Rd, Richmond, 3121, Victoria, Australia. Tel: \u00fe613 9426
\n8727. Fax: \u00fe613 9426 8734. E-mail: gavin.williams@epworth.org.au
\nISSN 0269\u20139052 print\/ISSN 1362\u2013301X online \u0002 2010 Informa Healthcare Ltd.
\nDOI: 10.3109\/02699052.2010.490517
\nincludes the ability to ascend and descend stairs.
\nThe ability to negotiate stairs is important for dayto-
\nday mobility. Expert clinicians strongly endorsed
\nthe stair items during the consultative phase in the
\ndevelopment of the HiMAT [1], yet in some
\nrehabilitation and community-based settings, a suitable
\nflight of stairs may not be available for testing.
\nTherefore, the secondary aim of this study was to
\ninvestigate the validity of summing the non-stair
\nitems to generate a total (but reduced) HiMAT
\nscore.
\nMethods
\nParticipants
\nData from the original sample of 103 people with
\nTBI recruited in the development of the HiMAT
\nwere re-analysed in this study [2].
\nProcedure and data analysis
\nRasch analysis was used to investigate the validity of
\nthe HiMAT scoring system without the stair items.
\nThe Conquest program [10] was used in the original
\ndevelopmental stages of the HiMAT. However, due
\nto recent advances in Rasch modelling, the
\nRUMM2020 [11] program was chosen for use in
\nthis study to investigate item fit, dimensionality,
\ninternal consistency, differential item functioning,
\nresponse dependency and targeting of the non-stair
\nHiMAT items. In particular, additional testing using
\nthe t-test procedure to compare scores from sub-sets
\nof items has been recommended when investigating
\ndimensionality [3].
\nThe procedures undertaken to assess the psychometric
\nproperties of the HiMAT were consistent
\nwith those recommended by Pallant and Tennant
\n[12] and Tennant and Conaghan [13].<\/p>\n

The overall
\nfit of the scale was evaluated using a chi-square
\nstatistic with a non-significant p-value indicative of
\nadequate fit to the Rasch model. Fit of the individual
\nitems and persons were assessed using two indicators:
\na non-significant chi-square statistic and a fit
\nresidual value within the range \u00022.5. Differential
\nitem functioning testing was conducted for age and
\nsex using analysis of variance.<\/p>\n

The presence of
\nresponse dependency amongst the items was investigated
\nby inspecting the residual correlation matrix
\nfor values exceeding \u00fe0.3. Dimensionality testing
\ninvolved conducting a series of t-tests to compare
\nRasch derived scores from two sub-sets of items
\nidentified from principal components analysis (PCA)
\nof the residuals.<\/p>\n

Less than 5% of tests should be
\nsignificantly different (or the lower bound of the
\nbinomial confidence interval should overlap by 5%)
\nfor the scale to be considered unidimensional.
\nA graph showing the distribution of Rasch derived
\nscores and corresponding item thresholds was used
\nto evaluate the targeting of the scale.
\nThe main purpose of the original HiMAT was to
\nestablish a scale which quantified the high level
\nmobility requirements for the societal roles of young
\nadults.<\/p>\n

Therefore, it was important to establish that
\nthe HiMAT was minimally susceptible to a ceiling
\neffect [14]. The exclusion of the stair items was
\nunlikely to introduce a ceiling effect to the revised
\nHiMAT because of their item location [2]. The
\ntargeting of the non-stair HiMAT items was investigated
\nto ensure the revised scale remained
\nFigure 1. Distribution of scores and item thresholds on the revised 8-item HiMAT scale.
\n1028 G. Williams et al.
\ndiscriminative for a range of abilities, particularly at
\nthe highest level.
\nA shorter version of the HiMAT, without the stair
\nitems, may also change the original minimal detectable
\nchange (MDC95) scores. The MDC95 scores
\nare used to determine the 95% confidence intervals
\nfor detecting clinically meaningful change. The
\nMDC95 scores for the revised HiMAT were recalculated
\nfrom the original data sets [14, 15] using the
\nformula:
\nMDC95 \u00bc Mean difference \u0002 1:96 \u0003 SE
\nwhere SE is the standard error of measurement
\nderived from a reliability study [15].
\nResults
\nRasch analysis of all HiMAT items
\nRasch analysis of all 13 HiMAT items showed
\nadequate fit to the model (p\u00bc0.82) with no
\nmisfitting items. Dimensionality testing, however,
\nindicated that the scale was multidimensional,
\nshowing a clear separation of the stair and nonstair
\nitems.<\/p>\n

Over 12% of respondents recorded
\nsignificantly different Rasch derived scores for
\nthese two sets of items. This value exceeds the
\nrecommended guideline of 5% and suggests that
\nthese two sets of items should not be combined to
\nform a total score.
\nRasch analysis of HiMAT non-stair items
\nRasch analysis of the nine non-stair items of the
\nHiMAT indicated good overall fit to the model
\n(p\u00bc0.99).<\/p>\n

However, dimensionality testing indicated
\nthat the scale was multidimensional, with
\nover 13% of respondents showing statistically significant
\ndifferent scores on two sets of items identified
\nfrom PCA of the residual correlation matrix.
\nRemoval of item 8 \u2018bound\u2013affected leg\u2019 resolved
\nthis dimensionality issue, with subsequent testing
\nidentifying 5.10% of cases with significantly different
\nscores.<\/p>\n

Although this value exceeded the recommended
\nvalue of 5%, the binomial confidence
\ninterval (CI: 1\u20139%) included the value of 5%,
\nsupporting the unidimensionality of the scale.
\nThe final 8-item solution (with item 8 removed)
\nshowed good model fit (p\u00bc0.93) (Table I), excellent
\ninternal consistency (PSI\u00bc0.96), no disordered
\nthresholds, no misfitting items (Table II) and no
\ndifferential item functioning for age or sex. All
\nresidual correlations were less than 0.34, suggesting
\nTable II. Individual item fit statistics for the final models of the HiMAT scale.
\nNo. Item Location SE Fit Resid df Chi Sq df p
\nHiMAT\u2014without stair items
\n1 walk \u00040.28 0.21 \u00040.78 82 0.64 2 0.72
\n2 walk (backward) \u00042.36 0.20 \u00040.23 82 1.04 2 0.59
\n3 walk (toes) \u00040.88 0.18 \u00040.05 82 0.51 2 0.77
\n4 walk (obstacle) \u00041.55 0.19 \u00041.07 82 0.96 2 0.62
\n5 run 0.94 0.17 \u00040.65 82 1.80 2 0.41
\n6 skip 1.92 0.17 \u00040.21 82 1.06 2 0.59
\n7 hop 2.41 0.17 \u00040.15 82 0.41 2 0.81
\n9 bound (non\u0004affected leg) \u00040.20 0.18 0.79 82 2.19 2 0.33
\nSE\u00bcStandard error, Fit Resid\u00bcFit Residual, Chi Sq\u00bcChi-square, df\u00bcdegrees of freedom, p\u00bcprobability.
\nTable I. Model fit statistics for original and revised HiMAT scale.
\nAction
\nAnalysis
\nno.
\nOverall
\nmodel fit
\nItem Fit Resid
\nM (SD)
\nPerson Fit Resid
\nM (SD) PSI
\n%
\nsignif t-tests
\nHiMAT\u2014all items 1 \u00022\u00bc19.38;
\ndf\u00bc26; p\u00bc0.82
\n\u00040.08 (0.52) \u00040.23 (0.68) 0.98 12.87%
\n(CI: 9\u201317%)
\nHiMAT\u2014without stair items 2 \u00022\u00bc7.07;
\ndf\u00bc18; p\u00bc0.99
\n\u00040.23 (0.63) \u00040.25 (0.90) 0.96 13.27%
\n(CI: 9\u201318%)
\nRemoval of item 8 3 \u00022\u00bc8.62;
\ndf\u00bc16; p\u00bc0.93
\n\u00040.29 (0.56) \u00040.21 (0.81) 0.96 5.10%
\n(CI: 1\u20139%)
\nFit Resid\u00bcFit Residual, df\u00bcdegrees of freedom, p\u00bcprobability, SD\u00bcstandard deviation, PSI\u00bcPerson Separation Index,
\nCI\u00bcconfidence interval.
\nRevised HiMAT 1029
\nno serious response dependency among the items.
\nTargeting was appropriate for this group of patients,
\nwith item thresholds covering the full range of scores
\n(Figure 1).
\nMDC95 scores
\nDue to the reduction in the number of items from 13
\nto 8, the maximum score for the revised version of
\nthe HiMAT is now 32.<\/p>\n

The MDC95 were recalculated
\nfor the revised 8-item HiMAT. The revised SE
\nof measurement was calculated at 0.79 (revised ICC
\n0.99, revised mean difference between test and
\nre-test scores was 0.42 and the revised standard
\ndeviation of the test and re-test scores were 7.82 and
\n7.97). The revised MDC95 was calculated to be
\n\u00041.13 to 1.97.
\nDiscussion
\nAlthough the intention of this study was to evaluate
\nhow the HiMAT functioned when clinicians did not
\nhave access to a flight of stairs, recent developments
\nin Rasch modelling identified a problem with
\ndimensionality, demonstrating a clear separation
\nbetween the stair and non-stair items. Removal of
\nthe stair items (and one additional item) resulted in
\na short 8-item scale with excellent psychometric
\nproperties.
\nThe separation of the stair and non-stair stair
\nitems into two distinct sub-groups is a somewhat
\nsurprising result.<\/p>\n

The majority of mobility outcome
\nmeasures used in neurological rehabilitation incorporate
\nstair items [4\u20139], yet dimensionality has rarely
\nbeen evaluated in the development of these scales.
\nThe use of Rasch analysis to develop or refine
\nmobility outcome scales is infrequent but increasing
\n[16]. In addition to the HiMAT, Belvedere and
\nde Morton [16] identified two further mobility scales
\nused in adult neurological rehabilitation which have
\nbeen evaluated with Rasch analysis.<\/p>\n

The ABILOCO
\n[17] was developed using RASCH analysis and the
\nDynamic Gait Index (DGI) [8] was refined from an
\n8-item to a 4-item scale following evaluation with
\nRasch analysis. A fourth scale, the Rivermead
\nMobility Index (RMI), has also been refined with
\nRasch analysis [18].
\nThe recent advances in Rasch analysis used to
\ninvestigate dimensionality involve the use of t-tests to
\ncompare scores derived from sub-sets of items
\nidentified using principal components analysis of
\nthe residuals. This method was not used to investigate
\nthe dimensionality of the ABILOCO, DGI or
\nRMI. The ABILOCO is a 13-item mobility questionnaire
\ndeveloped for stroke which includes reciprocal
\nstair ascent [17].<\/p>\n

Although developed and
\nvalidated with Rasch analysis, evaluation was
\nperformed on questionnaire responses and physical
\nperformance was not directly observed or tested.
\nA difference in dimensionality or item hierarchy
\nmay exist when comparing observed performance
\nwith self-report.<\/p>\n

The DGI is an 8-item scale developed
\nfor elderly people with balance and vestibular
\ndisorders. The original version was revised to four
\nitems when refined using factor analysis and Rasch
\nanalysis [19].<\/p>\n

The stair item was eliminated from the
\nfinal 4-item version due to a low single-construct
\nloading value identified using factor analysis. Rasch
\nanalysis was also used in the refinement of the RMI
\nwhich contains two stair items.<\/p>\n

The t-test procedure
\nwas not used to investigate the dimensionality of the
\nRMI and the only change to this questionnairebased
\nscale was to omit the most difficult item due to
\na low response rate.
\nThis current study is the first to investigate the
\ndimensionality of a mobility scale which includes
\nstair items. Further investigation is required to
\ndetermine whether stair items should be included
\nin mobility scales, particularly in view of the importance
\nto be able to negotiate steps and stairs in
\neveryday life.<\/p>\n

The results of this study demonstrate
\nthat the revised HiMAT is unidimensional and valid
\nto use in rehabilitation and community settings
\nwhere there is no access to stairs.<\/p>\n

The exclusion of
\nthe stair items from the revised HiMAT further
\nenhances the practicality, feasibility and clinical
\nutility of the scale.
\nThe original goal for developing the HiMAT was
\nto construct a measure of high-level mobility. The
\neight non-stair items retained on the revised version
\nof the HiMAT still accomplishes this goal as all three
\nnon-stair items which are more difficult than the
\nmost difficult stair item have been retained.
\nCompared to the original version of the HiMAT,
\nthe revised HiMAT no longer contains the two
\neasiest items (ascending and descending stair\u2013
\ndependent).<\/p>\n

This may make the revised HiMAT
\nmore susceptible to a floor affect because it is less
\nable to quantify people with severe mobility limitations,
\nyet many other mobility scales such as the
\nABILOCO [17], HABAM [20], FIM [21] or the
\nRMI [5] adequately quantify this level of ability.
\nMost importantly, the ability of the revised version
\nof the HiMAT to measure the high-level limitations
\nhas been retained.
\nWhen the non-stair items were evaluated, a
\nresidual problem with dimensionality was still evident.
\nRemoval of the \u2018bounding on to the moreaffected
\nleg\u2019 item resolved this issue.<\/p>\n

\u2018Bounding onto
\nthe more-affected leg\u2019 is very similar to \u2018bounding
\nonto the less-affected leg\u2019, yet the problem with
\ndimensionality was only associated with the first
\nitem. One possible explanation may relate to how the
\nitems were scored during the data collection phase
\n1030 G. Williams et al.
\nfor the HiMAT. \u2018Bounding onto the less-affected
\nleg\u2019 requires subjects to push-off their more-affected
\nleg which may be difficult, but is not usually
\nperceived to be unsafe as the subject can then land
\non their preferred or less-affected leg.<\/p>\n

In contrast,
\n\u2018bounding on to the more-affected leg\u2019 may enable
\nsubjects to generate a greater push-off than can be
\nsafely controlled when landing on the less-preferred
\nof more-affected leg. Hesitancy in landing on the
\nmore-affected leg may have led some of the participants
\nto alter their performance or to refuse to
\nattempt the task.<\/p>\n

When \u2018bounding onto the moreaffected
\nleg\u2019, failure and refusal were both scored as
\n\u20180\u2019. A \u20180\u2019 score due to inability to bound may be an
\naccurate representation of performance, whereas a
\n\u20180\u2019 score due to refusal may be an accurate representation
\nof ability or the impact of fear or anxiety on
\nperformance. Inability to differentiate between the
\n\u20180\u2019 scores limits investigations into the reasons for
\nthe dimensionality problem with this item.
\nThe MDC95 values for the revised 8-item HiMAT
\nwere calculated to reflect the new change scores for
\ndetecting clinically significant change. Results indicate
\nthat a 2-point increase over a 3-month period is
\nan indication of clinically significant improvement.
\nConversely, a 1-point deterioration over a 3-month
\nperiod is an indication of clinically significant deterioration.
\nThese values are important for assisting
\nclinicians to interpret scores and establishing treatment
\nplans and goal-setting.
\nConclusions
\nThe revised 8-item HiMAT has excellent psychometric
\nproperties and is valid for measuring highlevel
\nmobility in TBI. Exclusion of the stair items
\nimproves the clinical utility of the revised HiMAT
\ndue to the reduced number of items and time and
\nequipment requirements.
\nDeclaration of interest: The authors report no
\nconflicts of interest. The authors alone are responsible
\nfor the content and writing of the paper.
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\nCopyright of Brain Injury is the property of Taylor & Francis Ltd and its content may not be copied or emailed
\nto multiple sites or posted to a listserv without the copyright holder’s express written permission. However,
\nusers may print, download, or email articles for individual use.<\/p>\n

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ORIGINAL ARTICLE Further development of the High-level Mobility Assessment Tool (HiMAT) GAVIN WILLIAMS1,2, JULIE PALLANT3, & KEN GREENWOOD4 1Epworth Hospital, Melbourne, Australia, 2School of Physiotherapy, 3School of Rural Health, University of Melbourne, Australia, and 4School of Health Sciences, RMIT University, Read More …<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[490],"tags":[451,6,422,282,432,453,430,431,452],"class_list":["post-622","post","type-post","status-publish","format-standard","hentry","category-testing-and-evaluation","tag-assignment-help-tasks","tag-australia","tag-case-study-help","tag-management","tag-masters-in-business-administration","tag-sample-assignment-report","tag-sydney","tag-university-of-sydney","tag-writing-assignment-topics"],"_links":{"self":[{"href":"https:\/\/assignmenttask.com\/tutorhelp\/wp-json\/wp\/v2\/posts\/622","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/assignmenttask.com\/tutorhelp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/assignmenttask.com\/tutorhelp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/assignmenttask.com\/tutorhelp\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/assignmenttask.com\/tutorhelp\/wp-json\/wp\/v2\/comments?post=622"}],"version-history":[{"count":2,"href":"https:\/\/assignmenttask.com\/tutorhelp\/wp-json\/wp\/v2\/posts\/622\/revisions"}],"predecessor-version":[{"id":1018,"href":"https:\/\/assignmenttask.com\/tutorhelp\/wp-json\/wp\/v2\/posts\/622\/revisions\/1018"}],"wp:attachment":[{"href":"https:\/\/assignmenttask.com\/tutorhelp\/wp-json\/wp\/v2\/media?parent=622"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/assignmenttask.com\/tutorhelp\/wp-json\/wp\/v2\/categories?post=622"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/assignmenttask.com\/tutorhelp\/wp-json\/wp\/v2\/tags?post=622"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}