Rehabilitation and outcome measurement: where is Rasch analysis-going?

Outcomes are clinical or functional changes at the whole-person level. Measures are based on questionnaires which summate scores assigned to a series of items representing a person's variable. The metric properties of raw scores are known to be of limited validity. Yet, such variables represent the main target of outcome assessment in Rehabilitation Medicine as far as they may cover performances, perceptions and knowledge. Rasch statistical models, first available in English to a large readesrship in late 70s, allow to transform the arbitary raw scores into true linear measures. Rehabilitation seemed a privileged field for the application of Rasch models, yet these are still far from becoming popular. A bibliometric study was conducted across ten leading digital libraries. A MEDLINE search showed a dramatic increment of published papers covering the intersection between the MESH terms ''Rehabilitation'' and ''Outcome assessment'', which rose in from 5 to 4 302 between the 1981-90 and 2001-07 time frames, respectively. ''Rasch'' paper also rose remarkably from 35 to 539. When the triple intersection was considered, articles only rose from 0 to 12. Results point towards a privileged application of Rasch analysis to build and refine questionnaires, rather than to actually measuring people. Commentaries and suggestions are invited.

[A proposed check on the educational role of the professional nurse with the diabetic patient]. / Proposta di verifica del ruolo educativo dell'infermiere professionale con il paziente diabetico.

The nursing personnel of a day hospital for diabetic patients selected at random two 30 patients groups out of the cohort of those who had followed an educational course in the same day hospital, and out of the cohort of first contacts with the hospital. A formal evaluation has been made on two topics: the correctness of the technical execution of various procedures, the patient's perception of the factors which could play a role in determining the quality of communication between nurses and patients. Patients who were exposed to the original course appear to perform better. Along the same line, patients of the day hospital seem to share a status of conscious acceptance of the disease and of its direct personal implications.