The study of the validity and reliability of the Occupational Self-Assessment-traditional Chinese version.

INTRODUCTION: Health professionals who work in mental healthcare settings need to use standardised, objective instruments; however, it is also extremely important that they maintain a client-focused perspective. The purpose of this study was to investigate the validity and reliability of the 'Traditional Chinese version of the Occupational Self-Assessment' (TC-OSA). METHODS: A total of 593 participants with mental illnesses participated in the study. The data were analysed using confirmatory factor analysis as well as the Rasch measurement model. RESULTS: The results of our analysis revealed that the TC-OSA encompasses four domains: self-performance (11 items), self-habituation (5 items), self-volition (5 items) and environment (8 items). Most of the items within each domain were found to have a good fit with the Rasch measurement model, whereas the CFA index was found to have a good fit for only three of the domains, the one exception being the environment domain. CONCLUSIONS: We suggest applying the scale in clinical practice to identify the priority of intervention and as a measure for changes in outcomes. Further development and refinement of the environmental domain is guaranteed.

Reliability and validity of the self-reported Activities of Daily Living Scale for people with mental illness.

BACKGROUND/OBJECTIVES: Patient-reported outcome measures have been found to be an effective method of reflecting client perspectives on their personal health condition. The primary aim of this study was to determine the reliability and validity of the self-reported Activities of Daily Living Scale (sf-ADLS) using Rasch analysis in Taiwan. METHODS: A total of 455 people were included in this study; 224 were persons with mental illness and 231 were healthy adults. We applied Rasch analysis as the means of testing the psychometrics of the scale. RESULTS: The final version of the sf-ADLS used in this study included 14 items, with no differential item functioning being discernible on the gender variable. The scale was found to be of use in classifying the subjects into four levels of independence. CONCLUSIONS: The revised sf-ADLS conforms to the Rasch measurement model in the formulation of a unidimensional scale. The scale can be used to measure the level of independence with acceptable reliability (internal consistency as 0.9) and validity.

Life Adaptation Skills Training (LAST) for persons with depression: A randomized controlled study.

BAKGROUND: To investigate the efficacy of the "Life Adaptation Skills Training (LAST)" program for persons with depression. METHODS: Sixty-eight subjects with depressive disorder were recruited from psychiatric outpatient clinics in Taipei city and were randomly assigned to either an intervention group (N=33), or a control group (N=35). The intervention group received 24-sessions of the LAST program, as well as phone contact mainly related to support for a total of 24 times. The control group only received phone contact 24 times. The primary outcome measure utilized was the World Health Organization Quality of Life-BREF-Taiwan version. Secondary outcome measures included the Occupational self-assessment, the Mastery scale, the Social support questionnaire, the Beck anxiety inventory, the Beck depression inventory-II, and the Beck scale for suicide ideation. The mixed-effects linear model was applied to analyze the incremental efficacy of the LAST program, and the partial eta squared (ηp(2)) was used to examine the within- and between- group effect size. RESULTS: The subjects who participated in the LAST program showed significant incremental improvements with moderate to large between-group effect sizes on their level of anxiety (-5.45±2.34, p<0.05; ηp(2)=0.083) and level of suicidal ideation (-3.09±1.11, p<0.01; ηp(2)=0.157) when compared to the control group. The reduction of suicidal ideations had a maintenance effect for three months after the end of intervention (-3.44±1.09, p<0.01), with moderate between-group effect sizes (ηp(2)=0.101). Both groups showed significant improvement on overall QOL, overall health, physical QOL, psychological QOL, level of anxiety, and level of depression. The within-group effect sizes achieved large effects in the intervention group (ηp(2)=0.328-0.544), and were larger than that of the control group. LIMITATIONS: A small sample size in the study, a high dropout rate, lower compliance rates for the intervention group, and lacking of true control group. CONCLUSIONS: The occupation-based LAST program, which focuses on lifestyle rearrangement and coping skills enhancement, could significantly improve the level of anxiety and suicidal ideations for persons with depression.

Examining the validity and reliability of the Taita symptom checklist using Rasch analysis.

BACKGROUND/PURPOSE: The Taita symptom checklist (TSCL) is a standardized self-rating psychiatric symptom scale for outpatients with mental illness in Taiwan. This study aimed to examine the validity and reliability of the TSCL using Rasch analysis. METHODS: The TSCL was given to 583 healthy people and 479 people with mental illness. Rasch analysis was used to examine the appropriateness of the rating scale, the unidimensionality of the scale, the differential item functioning across sex and diagnosis, and the Rasch cut-off score of the scale. RESULTS: Rasch analysis confirmed that the revised 37 items with a three-point rating scale of the TSCL demonstrated good internal consistency and met criteria for unidimensionality. The person and item reliability indices were high. The TSCL could reliably measure healthy participants and patients with mental illness. Differential item functioning due to sex or psychiatric diagnosis was evident for three items. A Rasch cut-off score for TSCL was produced for detecting participants' psychiatric symptoms based on an eight-level classification. CONCLUSION: The TSCL is a reliable and valid assessment to evaluate the participants' perceived disturbance of psychiatric symptoms based on Rasch analysis.

Psychometric properties of the Mastery Scale-Chinese version: applying classical test theory and Rasch analysis.

AIMS: This study examines the reliability and validity of the Mastery Scale-Chinese version (MS-C) when applied to three groups diagnosed with major depression, schizophrenia, or HIV/AIDS. METHODS: The individuals participating in the study were recruited from outpatient units of a medical center and a municipal hospital in northern Taiwan. The study sample (n = 2009) included 237 patients with depressive disorders, 160 with schizophrenia, and 1612 with HIV/AIDS. The reliability and construct validity of the MS-C was evaluated by confirmatory factor analysis (CFA) and Rasch analysis. RESULTS: The results of the CFA showed that the MS-C has adequate construct validity with all indices meeting the criteria, except for chi-square values. The Rasch analysis supported the four-point rating scale structure and a unidimensional construct of the MS-C. The DIF analysis showed that all items demonstrated stable measurement properties among the different diagnosis groups (major depression, schizophrenia, HIV/AIDS). CONCLUSION: This study found that MS-C has acceptable psychometric qualities in terms of reliability, construct validity, rating scale performance, and item characteristics when applied to patients with depression, schizophrenia, and HIV/AIDS in Taiwan.

Reliability and validity of the Paediatric Volitional Questionnaire - Chinese version.

OBJECTIVE: The purpose of this study is to examine the psychometric properties of the Chinese version of the Paediatric Volitional Questionnaire (PVQ-C) for use amongst preschoolers in Taiwan. METHODS: Forty preschoolers with developmental delays were randomly selected from northern Taiwan, along with another 40 typically developing preschoolers. The data was analysed using Rasch measurement model for construct validity and classical test theory for item reliability, intra- and inter-rater reliability, and convergent validity. RESULTS: The results indicated the PVQ items of PVQ-C fit into a unidimensional continuum of volition (logit -6.63~3.05) with 2 items representing differential item functioning for diagnostic group. The person-fit statistics showed that 83% participants' response could be appropriately estimated and stratified (separation index = 1.86). Using a modified 3-point rating scale resulted in acceptable item reliability (0.97), intra-rater reliability (0.412-1.0), 86% PVQ items in test-retest reliability > 0.4, and convergent validity (r = 0.562-0.656). CONCLUSIONS: The PVQ-C is regarded as a reliable and valid instrument for assessing the volitional status of children, as a reference for subsequent clinical judgement, and for client-centred intervention programmes and treatment effects.

A longitudinal study of the predictors of quality of life in patients with major depressive disorder utilizing a linear mixed effect model.

We set out in this study to examine a longitudinal dataset using a linear mixed effects model. Our ultimate aim is to identify predictors of the quality of life (QOL) domains and items amongst patients suffering from major depressive disorders. Four categories of variables are included in our analysis, composed of 'personal predisposition', 'psychosocial', 'illness-related' and 'time', while the outcome variables for this study are the 'physical', 'psychological', 'social' and 'environmental' domains of QOL, in conjunction with all of the items within the scale. A total of 104 subjects from an outpatient clinic of a university-affiliated hospital participated in this longitudinal study, with a one-time follow up being carried out on 70 of these subjects (67.3%) who agreed to participate in the follow-up study. The 'severity of depression', 'sense of competence' and 'sense of mastery', 'use of anti-depressant medication' and 'environmental resources' are found to be significant predictors of the detailed aspects of QOL. Of these, 'symptom severity', 'sense of competence' and 'sense of mastery' were found to occur most often. Finally, the results of the present study demonstrate that 'illness-related' and 'psychosocial' categories are capable of predicting the various QOL domains for patients suffering from depression.

Mastery and stigma in predicting the subjective quality of life of patients with schizophrenia in Taiwan.

A total of 199 outpatients with schizophrenia are assessed in this study for their sense of mastery, stigma, social support, symptom severity, and quality of life (QOL), with path models being used to test the direct and indirect effects of these factors on the physical, psychological, social, and environmental QOL domains. Symptoms, stigma, mastery, and social support are found to be key direct predictors for all 4 QOL domains, with mastery having the greatest direct effect on QOL, whereas stigma has the greatest indirect effect, although mediated by mastery and social support. Such results imply that in nonwestern cultures, mastery and stigma are still crucial factors affecting the QOL of patients with schizophrenia. Our results highlight the importance of enhancing the mastery of such patients and reducing the associated stigma when designing treatment programs. To enhance the QOL of patients with schizophrenia, interventions which can optimize the meaningful use of time may well enhance the mastery of these patients, whereas strategies aimed at improving their ability to cope with perceived stigma, at both individual and community levels, may help to reduce the detrimental effects.

Quality of life for patients with major depression in Taiwan:A model-based study of predictive factors.

The 'quality of life' (QOL) for patients suffering from depression is affected by four factors: stigma, social support, mastery and depressive symptoms. The purpose of this study was to develop and empirically validate an appropriate path model for the QOL of patients suffering from major depression. We recruited a total of 237 patients suffering from depression from the outpatient psychiatry department of a university-affiliated hospital in northern Taiwan. The sample was predominantly female (74.3%), had at least a high school level of education (79.7%), had a mean age of 46.95 years, and were living with their families (87.3%). Path analysis was used to identify the 'best fit' model for the QOL of the patients in four domains: physical, psychological, social and environmental. The key determinant for all QOL domains is found to be the intensity of the depressive symptoms, with social support also affecting QOL both directly and indirectly, whilst stigma is found to have an indirect effect on QOL mediated by the intensity of the depressive symptoms, mastery and social support. We conclude that more effective improvements in all aspects of QOL for patients suffering from depression could be achieved by the provision of comprehensive intervention programs aimed at reducing stigma, as well as placing greater emphasis on a reduction in the patients' depressive symptoms, and enhancements to their social support and mastery.

Evaluation of the psychometrics of the Social Impact Scale: a measure of stigmatization.

As stigmatization has a large impact on patients, therapists need a measure of this impact to provide patients with adequate services. This study, therefore, examined the reliability and validity of the Social Impact Scale (SIS) when applied to three groups of individuals diagnosed with major depression, schizophrenia, or HIV/AIDS. The study sample (N=580) included 237 patients with depressive disorder, 119 with schizophrenia, and 224 with HIV/AIDS. Of these, 56% were men, 45.5% had an elementary school education or less, 48% were employed, and 56% were single. The Rasch measurement model, an item-response theory, was used to analyze the SIS structure and quality. The Rasch model solves several statistical problems of traditional measurement theory, such as misuse of ordinal data as interval data and sample dependence. Rasch analysis indicated that the 24 items of the SIS fit the measurement model. The match between item difficulties and person abilities was adequate. All items showed acceptable rating scale structure. The separation reliability of the scale reached 0.99. The SIS had acceptable psychometric qualities in terms of internal consistency, item validity, person validity, sensitivity, and concurrent validity when applied to patients with depression, schizophrenia, and HIV/AIDS in Taiwan.

Reliability and validity of the Canadian Occupational Performance Measure for clients with psychiatric disorders in Taiwan.

The purpose of the study was to examine the reliability and validity of the Canadian Occupational Performance Measure (COPM) in Taiwanese clients with psychiatric disorders. The COPM was translated into Mandarin and tested on 141 Taiwanese clients. The average age of the clients was 35.6 years; 94% were diagnosed with schizophrenia. The results of the study showed that the test retest reliability of the COPM was r = 0.842. The COPM identified occupational performance problems that included self-care (37%), productivity (25%), and leisure occupations (20%). Fifty percent of the therapists were receptive in adapting the client-centred approach and applying the COPM in their clinical practice. It was concluded that the COPM can be applied reliably to Taiwanese clients. Furthermore, the COPM was valuable in identifying information related to occupational performance that could not be identified elsewhere. Since 50% of the therapists felt reluctant about the appropriateness of the client-centred approach in their culture, it was important to examine the gap between clients' judgements and actual performance, as well as to evaluate the feasibility of the client-centred concept in clinical practice. Finally, the concept of the client-centred approach needs to be disseminated and communicated to the occupational therapy profession in order that the COPM can be adequately applied in mental health practice.

A causal model of rehabilitation resource use for subjects with spinal cord injury in Taiwan.

OBJECTIVE: The aim of this study was to construct an adequate causal model of rehabilitation resource use based on a Taiwanese rehabilitation database system. DESIGN: Cross-sectional analysis of data from a Taiwanese rehabilitation database system. SUBJECTS: Records from 68 patients (51 men, 17 women; mean age 43 years) with spinal cord injuries were used in the study. METHODS: Path analysis was used to identify a better-fitted model for patients with spinal cord injuries. RESULTS AND CONCLUSION: The results showed that the final causal model fits the data well. The findings also reveal that activities of daily living have the largest total effect on length of stay, whereas subjective well-being and gender have indirect effects on length of stay, mediating through activities of daily living and subjective well-being, respectively. The impact of subjective well-being on the length of stay in hospital for patients with spinal cord injuries deserves special attention, as the quality of life issue plays a vital role in rehabilitation of these patients. The influence of subjective well-being on activities of daily living suggests that therapy targeted at improving patients' subjective well-being is necessary. Additionally, the impact of sexual dysfunction of patients with spinal cord injuries should be investigated further.

Inter-rater and test-retest reliability of the Taiwanese Rehabilitation Functional Scale.

The need of a standardized evaluation tool for clinical practice is acknowledged by occupational therapists worldwide. The purpose of this study was to examine the inter-rater and test-retest reliabilities of the Taiwanese Rehabilitation Functional Scale (TaRFS) developed in Taiwan. Seventy-five subjects with varying diagnoses were recruited to participate in the study. They came from an inpatient re-habilitation unit within a university-affiliated hospital. All participants were tested on a functional measure of their independence on activities of daily living and cognitive-social tasks, and of their sense of well-being. The Activity of Daily Living (ADL) and CognitiveSocial Skills (CSS) subscales of the TaRFS were found to be reliable across raters and times. But individual items on the Subjective Well Being subscale were not stable across time. The results indicated that the ADL subscale as well as most items in the CSS subscale of the TaRFS can be utilized reliably in clinical practice. The SWB subscale of the TaRFS may need further revision in order to be used stably across time. The development of the TaRFS and future revision of the scale can be beneficial for occupational therapists in Taiwan to provide evidence of their intervention efficacy.