목적 : 본 연구는 라쉬모델을 적용하여 아동 및 청소년을 위한 참여와 환경평가(Participation and Environment Measure-Children and Youth; PEM-CY)의 평정척도를 개발하고자 하였다. 연구방법 : 5~13세 비장애 및 장애 아동을 양육하는 부모 184명을 대상으로 PEM-CY의 자료를 수집하 였다. 원자료는 라쉬모델을 적용하여 PEM-CY의 가정, 학교 및 지역사회 영역 척도(참여빈도, 몰입도, 환경적 촉진/방해요인)에 대한 평정척도 분석을 실시하였다. 결과 : 참여빈도 7점 척도는 가정 영역에서 3점 척도, 학교 및 지역사회 영역에서 4점 척도가 적합하였다. 몰입도 5점 척도는 가정, 학교 및 지역사회 영역 모두 3점 척도가 적합하였다. 환경적 촉진/방해요인 3점 척도는 모든 영역에서 적합한 것으로 분석되었으나, 4점 척도는 학교 영역에서만 적합하였으며, 가정 및 지역사회 영역에서는 3점 척도가 적합한 것으로 분석되었다. 결론 : 라쉬모델을 적용하여 PEM-CY의 영역별 측정 변수에 따른 평정척도를 개발하였다. 새롭게 개발한 PEM-CY의 평정척도가 평가 과정에서 유용하게 적용되길 기대하며, 향후에는 다양한 대상자 및 인구학적 특성을 고려하여 활동참여 양상 및 환경적 촉진/방해 요인에 대한 연구가 필요하다.

목적 : 본 연구는 다양한 운전상황에서의어려움 정도를 평가하는 안전운전행동 체크리스트를 개발할 때 수집된 데이터를 라쉬분석을 활용하여 부적절한 문항을 확인하고 타당도를 검증하고자 하였다. 연구방법 : 안전운전행동체크리스트는 37문항으로 개발되었고 이 연구 참여한 대상자는 60세 이상 노인 운전자 의명21의1 원데이터를 활용하였다. 안전운전행동 체크리스트(자가보고식 노인 안전운전 측정도구)의 타당도 검증을 위해 라쉬분석을 사용하였고 Winsteps 프로그램을 통해 문항 적합성, 문항의 난이도, 평정척도의적합성을 검증하였다. 결과 : 탐색적 요인분석 결과 운전상황, 외부환경과 날씨, 주차, 일반적 운전상황 4개 요인으로 추출되었다. 라쉬 분석을 통해 1문항이 삭제되어 36문항이 적절하다고 분석되었다. 또한 문항의 난이도를 파악할 수 있었는데 문항 난이도 분석결과 가장 어려운 문항은 “눈길이나 빙판길에서 운전하기’, 가장 쉬운 문항은 “신호등 지키기”로 문항이었다. 결론 : 본 연구에서는 라쉬분석과 요인분석을 이용하여 안전운전행동 체크리스트의 타당도를 입증하였고 운전요인으로 4가지 요인을 확인하였다. 또 최종 문항의 난이도를 파악할 수 있었다. 향후 국내 상황에 적합한 운전 수행능력을 검증할 수 있는 다양한 평가와 중재가 개발되어 작업치료 임상현장에서 운전재활 기초자료로 활용되기를 기대한다.

Background: Rasch analysis has the advantage of placing both the items and the person along a single ratio scale and calibrates person ability and item difficulty onto an interval scale by logits. Therefore, Rasch analysis has been recommended as a better method for evaluating functional outcome questionnaires than traditional analyses. Objects: The aim of current study was to investigate item fit, item difficulty, rating scale, and separation index of the Korean version of the Fullerton Advanced Balance (KFAB) scale using Rasch analysis. Methods: In total, 93 patients with stroke (male=58, female=35) participated in this study. To investigate the item fit, difficulty, rating scale, and separation index of the KFAB scale, Rasch analysis was completed by the Winsteps software program. Results: In this study, all items of the KFAB scale were included in the Rasch model. The most difficult item was ‘standing with feet together and eyes closed’, and the easiest item was ‘two-footed jump’. The rating scale was a 4-point scale instead of the original 5-point scale. Person and item separation indices showed high values that can identify a person with a wide range of balance ability. Conclusion: The KFAB scale appears to be a reliable and valid tool to assess balance function in patients with stroke. Furthermore, the scale was found to discriminate among stroke patients of varying balance abilities.

Background: The Pediatric Balance Scale (PBS) was developed to assess of balance ability in children with balance problem. The PBS was translated into Korean and its reliability had been studied. However, it had need to be verified using psychometric characteristics including item fit and rating scale. Objects: The purpose of this study was to investigate the item fit, item difficulty, and rating scale of the Korean version of PBS using Rasch analysis. Methods: In total, 40 children with cerebral palsy (CP) (boy=17, girl=23) who were diagnosed with level 1 or 2 according to the Gross Motor Function Classification System participated in this study. The PBS was performed, and was verified regarding the item fit, item difficulty, rating scale, and separation index and reliability using Rasch analysis. Results: In this study, the ‘transfer’, and ‘turning to look behind left and right shoulders while standing still’ item showed misfit statistics. in total 40 children with CP. Also, ‘transfer’, ‘standing unsupported with feet together’ and ‘standing with one foot in front’ items showed misfit statistics in diplegia CP group. Regardless of the classification of CP, the most difficult item was ‘standing on one foot’, whereas the easiest item was ‘sitting with back unsupported and feet supported on the floor’. The 4 rating scale categories of PBS were acceptable with all criteria. Both item and person separation indices and reliability showed acceptable values. Conclusion: The PBS has been proven reliable, valid and is an appropriate tool, but it needs to modify the items of PBS according to CP classification.

Background: Rasch analysis estimates the probability that a respondent will endorse an item and select a particular rating for that item. It has the advantage of placing both the items and the person along a single ration scale and calibrates person ability and item difficulty onto an interval scale by logits. In addition, Rasch analysis is a useful tool for exploring the validity of questionnaires that have been developed using traditional methods. Therefore, it has been recommended as a method for developing and evaluating functional outcome measures. Objects: The purpose of this study was to investigate the item fit, item difficulty, and rating scale of the Korean version of the Fullerton Advanced Balance Scale (KFAB) using Rasch analysis. Methods: Total 97 subjects (39 males and 58 females) with dwelling elderly adults were participated, but 3 people were excluded for misfit persons. Rasch analysis was then done by means of the Winsteps program to determine the item fit, item difficulty, rating scale, and reliability of the KFAB. Results: In this study, the ‘standing with feet together and eyes closed’, ‘two-footed jump’, ‘walk with head turns’, and ‘stand on foam, eyes closed’ items shown misfit statistics. The most difficult item was ‘stand on one leg’, whereas the easiest item was ‘turn in full circle’. The rating scale was acceptable with all criteria. Both item and person separation indices and reliability showed acceptable values. This would indicated that each domain covers a useful range of item difficulty that is appropriate for measuring a person with a wide range of functional ability. Conclusion: The KFAB has been proven reliable, valid and an appropriate tool with which to evaluate the balance of the elderly people.

The versions of the Oswestry disability questionnaire (ODQ) is regarded as one of the most extensively used condition-specific instruments measuring disability resulting from low back pain. It has been shown to have adequate psychometrics, reliability, validity, and responsiveness as a whole, yet the summated total score of the instrument often provide little information to rehabilitation clinicians. A keyform analysis based on Rasch measurement model is an innovative way of illustrating the specific test items that an individual may or may not perform. By applying the keyform of the Rasch measurement model to the ODQ, rehabilitation clinicians may able to select more challenging ODQ items matching an individual’s ability and document them as attainable treatment goals. The results demonstrated how a keyform analysis assist to setting possible goals for the treatment of individuals with low back pain. Forty-two individuals with low back pain were recruited from rehabilitation clinics in Gainesville, Florida. A series of Rasch analyses on the 10 items of the ODQ were performed using Winsteps software. The performance of two individuals on those 10 items was illustrated on the keyform. The keyform analysis of the Rasch measurement model may be translated into a useful tool for making clinical judgements.

목적 : 본 연구는 문항반응이론에 근거한 라쉬분석을 적용하여 뇌졸중 환자의 연하기능 검사를 개발하는 것이다. 연구방법 : 뇌졸중으로 인한 연하장애 환자 153명을 대상으로 5개 영역에 24개 항목으로 구성된 예비 연하기능 검사를 수집하였다. 수집된 자료는 라쉬분석을 적용하여 대상자 및 항목의 적합도와 항목 난이도, 분리신뢰도, 평정척도 분석 을 실시하였다. 최종적으로 요인분석을 통해 항목의 영역을 분류하였다. 결과 : 153명의 대상자 중 11명이 부적합한 대상자로 판정되었으며, 23개 항목 중 6개 항목이 부적합 판정을 받았다. 부 적합한 항목은 1)폐렴과거력, 2)구강감각, 3)구역반사, 4)비강/구강 역류, 5)삼킴지연, 6)삼킴 후 천명이었다. 항목의 난이도에서 가장 어려운 항목은‘후두거상’으로 나타났으며, 가장 쉬운 항목은‘각성도’로 분석되었다. 연하기능 검사 의 평정척도(0~4점)는 적합한 척도 범주로 분석되었으며, 항목에 대한 분리신뢰도는 .98, 대상자에 대한 분리신뢰도 는 .95로 분석되었다. 최종적으로 요인분석을 통해 4개 영역에 17개 항목으로 구성된 연하기능 검사를 개발하였다. 결론 : 라쉬분석을 적용하여 뇌졸중 환자를 대상으로 한 연하기능 검사의 신뢰도와 타당도를 입증하였다. 연하기능 검사 의 각 항목들은 임상적으로 환자의 기능과 회복 수준을 세부적으로 파악할 수 있으며, 항목들의 난이도 수준을 고려하 여 중재 가이드라인을 제시할 수 있을 것으로 기대한다.

The purpose of this quantitative research was to examine whether there were statistically significant differences in Islamic elementary public school teachers’ curriculum orientation and teaching conception across demographic variables of gender, age, and teaching experience. Data were collected through questionnaires from 65 Islamic elementary public school teachers. Data were analysed through Rasch analysis and tests of inferential statistics. The results of the data analysis show that, over all: 1) the teachers’ curriculum orientation tended to be “technological” and “academic” rather than “social reconstructionistic”; and 2) the teachers tended to conceptualize teaching as “apprenticeshipdevelopmental” and “knowledge transmission” rather than “nurturing” or “social reform”. Tests of inferential statistics revealed a significant difference between male and female teachers’ conception of teaching. A significant difference was also found in the teachers’ curriculum orientation across the demographic variable of teaching experience. No significant difference was found across the variable of age. Correlations were identified between the teachers’ curriculum orientation and teaching conception. The findings of this study provide evidence for policy makers, school leaders, researchers, parents, and teacher educators that the curriculum orientation and teaching conception of the majority of the teachers seems to be incompatible with the nature of character education that necessitates teachers to be “nurturing” and “social reconstructionistic”. In addition, evaluation and reorientation of paradigms and approaches in teacher education and educational objectives and further research are suggested.

The purpose of this study was to review existing assessment tools for patients with low back pain and improve them through combination. A total of 314 patients with low back pain participated. Their condition was assessed using the Oswestry Disability Questionnaire (ODQ), the Quebec Back Pain Disability Scale (QBPD), and the Back Pain Functional Scale (BPFS). Rasch analysis was applied to identify inappropriate items, item difficulties, and the separation index. In this study, the 'sex life' item of the ODQ (10 items) and the 'sleeping' item of the BPFS (12 items) showed misfit statistics, whereas all items of the QBPD (20 items) were appropriate. After combining the ODQ, QBPD and BPFS, Rasch analysis was applied. The 'pain intensity', and the 'sex life' item of the ODQ and the 'throw a ball' item of QBPD showed misfit statistics. These 3 items were retained for further analysis. The remaining 42 combined ODQ-QBPD-BPFS items were arranged according to difficulty. For all subjects, the most difficult item was 'pain intensity', whereas the easiest was 'take food out of the refrigerator'. As the separation index of 42 combined ODQ-QBPD-BPFS was higher than that of the three questionnaires separately, difficulty of items varied with some need for rearrangement. The results of this study confirmed the possibility and need for a new back pain disability assessment tool, and produced one. Further study is needed to refine the questionnaire in consideration of psychosocial and occupational factors.

Three hundred and fourteen low back pain patients completed the Korean version of the Oswestry Disability Questionnaire (KODQ) and the Rasch analysis was then applied to identify the inappropriate items and to determine ODQ item difficulties according to a subject's characteristics. For women and youths, the 'sex life' item showed misfit statistics, whereas for older subjects it was the 'pain intensity' and 'standing' items. Also, in the acute low back group the 'pain intensity', 'standing' and 'sex life' items showed misfit statistics. For all subjects, the most difficult item was 'pain intensity', whereas the easiest item was 'walking'. But for the older and acute groups 'lifting' was the most difficult item and for those who have a visual analogue scale score of 3 or less 'sitting' was the most difficult item. These results show that differential item functioning is present in several items according to sex, age, acute and chronic pain, and VAS score. This study may be useful for adjusting the KODQ item difficulties for low back pain patients with different characteristics

This study analyzes a nationwide English placement test in the Rasch framework Data were obtained from 297 first-year junior high school students. The assessed person (.75) and item reliability (.95) indicate that the test was fairly consistent and reproducible with other samples of examinees. About 60% of total variation was explained under the assumption of unidimensionality. The person separation index suggests that two and a half ability levels can be differentiated by means of the test. Overall, the ability distribution of students was higher than the difficulty distribution of items. The fìt statistics identified a few misfìt items, but their impact on the utility of the test appears nonsignificant.

The Functional Independence Measure (FIM) is widely used to determine the dependency of activity of daily living in rehabilitation patients. The purposes of this study were to evaluate the unidimentionality of the FIM physical items and to analyze the validity of cross-functional levels in stroke survivors in Korea. Thirteen physical items of FIM were rated according to an ordinal scale of a 7-level classification. Two hundred and seventy-nine patients participated in the study (age range 18~92 years and 57% male). Six items-eating, bladder control, bowel control, transfer to and from the bed/wheelchair, transfer to and from the toilet, and bathing-showed misfits with the Rasch model. The most difficult item was 'bathing', the easiest item was 'bowel control'. Although there were several differences within functional levels, the hierarchical order of item measures was rather similar. 'Bathing' was the most difficult in high level patients (above 60), however 'stairs' was most difficult in the middle level (41~60) group. In the low level group (below 40), 'toileting' was the most difficult. In conclusion, the present study has shown several differences of item difficulty among functional levels. This result will be useful in planning interventions, and developing rehabilitation programs for stroke survivors.

The purposes of this study were to assess and modify the original classification categories of the modified Oswestry Low Back Pain Disability Questionnaire (ODQ) and to determine the unidimensionality of the modified ODQ applying Rasch Analysis. The data were obtained from 108 work-related low back pain patients by physical therapists. Construct validity of the scale using the Rasch model required the structure of the rating scale to be modified from 6 response levels to 4 response levels. Eight items from the modified ODQ fit the Rasch model. The items, "pain intensity" and "social life" showed misfit statistics. In general, the order of item difficulty of the remaining 8 items showed a logical item difficulty hierarchy with the "changing degree of pain" item being the most difficult and the "walk" item being the easiest. The results showed that further study is needed to expand the construct of ODQ including additional higher-level items related to work activities. This study may be useful for establishing a standard method to assess the functionality of low back pain patients.

목적 : 본 연구의 목적은 문항반응이론에 기초한 라쉬모형을 적용하여 뇌졸중 외래환자의 일상생활수행 평가도구를 개발하는 것이다. 연구방법 : 연구 대상자는 뇌졸중 외래환자로 169명이었다. 조사방법은 사전연구에서 항목의 중요도로 수집된 23개의 일상생활수행 평가항목으로 구성된 설문지를 사용하였다. 조사자료는 전국 18개 재활기관에서 작업치료사가 평가한 결과를 수집하여 Winsteps 프로그램으로 라쉬분석을 하였다. 결과 : 7개 항목이 부적합한 항목으로 판정되었으며, 16개 항목이 적절한 항목으로 채택되었다. 뇌졸중 외래환자의 일상생활 수행능력은 -6.32~6.23 로짓으로 표시할 수 있으며, 표준화점수로 표시하기 위한 변환식은 "점수=(로짓점수+6.32)/(6.32+6.23)100" 이었다. 일상생활 수행능력을 평가하기위한 항목을 난이도 순서에 따라 배열하였다. 가장 어려운 항목은 보행영역의 '계단 오르내리기' 항목이었으며, 가장 쉬운 항목은 식사하기 영역의 '음료 마시기’항목이었다. 결론 : 라쉬분석을 이용하여 개발된 뇌졸중 외래환자의 일상생활수행 평가도구는 신뢰도와 타당도가 입증된 객관적인 도구이다.

The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is a valid and widely used instrument for the assessment of osteoarthritis patients. In this study, data was obtained from the out-patients with painful osteoarthritis of the knee. One hundred-three out-patients were interviewed by physical therapists. In an exploratory way, a Korean version of the KWOMAC was analyzed for unidimensionality, item separation, and item difficulty using the Winsteps programs. Ninety-five patients with osteoarthritis of the knee over 65 years were analyzed for Rash analysis. In the analysis several functional items poorly fit to the model. These items included "heavy domestic duties" and "standing". In the pain domain, one item ("at night while in bed") did not fit the model. In the stiffness domain one item ("after sitting, lying, or resting later in the day") did not fit the model. Although 4 items from the 3 domains (pain, stiffness, function domain) do not fit well, the KWOMAC domains were confirmed by Rasch analysis. Thus the KWOMAC needs to be further examined before it can be used to properly determine the health status of the elderly with OA.

This study was designed to examine, applying Rasch analysis based on item response theory, the questionnaires of the Activities-Specific Balance Confidence (ABC) scale for the elderly. The subjects were 99 institutional older adults and clients of social welfare facilities. The subjects (17 men, 72 women) ranged in age from 65 to 94 years (mean age 76.5 yrs). The Winsteps software was used to assess whether the ABC scale fits the Rasch model, to estimate the score and to refine the rating scale. The results are as follows. Twenty-two subjects were excluded as misfit persons. Four items were found to be misfits and the order of difficulty of the remaining 12 items was rearranged. Their balance confidence is indicated by -.64~1.12 logit, and the transformation formula is score=[(logit score+2.76)/(2.76+3.48)]100. The most difficult item was "Walk outside in icy sidewalks" and the easiest item was "Walk around house." In conclusion, the ABC scale for the elderly has been proven reliable and valid. Therefore, it is expected to be used as an effective examination tool for treatment planning and screening for older adults.

목적 : 문항반응이론에 기초한 Rasch모형을 적용하여 뇌졸중 입원환자의 일상생활수행 평가도구를 개발하는 것이다． 연구방법 : 2002년 8월 5일부터 2005년 4월 20일까지 전국 18개 재활기관에서 뇌졸중 입원환자 308명을 대상으로，작업치료사가 평가한 6개 영역의 23개 항목으로 구성된 설문지 결과를 수집하여 Winsteps 프로그램으로 라쉬분석하였다． 결과 : 3개 항목이 부적합한 항목으로 판정되었으며，남은 20개 항목의 난이도 순서를 배열하였다．뇌졸중 입원환자의 일상생활 수행능력은 -6.77~6.73 로짓으로 표시할 수 있으며，표준화점수로 표시하기 위한 변환식은 "점수 =（로짓점＋6.77)/ (6.77+6.73) 100" 이었다．평가항목의 난이도는 가장 어려운 항목은 보행영역의 ‘계단 오르내리기’ 항목이었으며，가장 쉬운 항목은 식사하기 영역의 ‘음료 마시기’ 항목 이었다． 결론 : 라쉬분석을 이용한 뇌졸중 입원환자의 일상생활수행 항목의 적합도와 난이도에 관한 결과제시로 개발되었으며，신뢰도와 타당도가 입증된 객관적인 평가도구이다．

This study was designed to examine, using Rasch analysis, the rating scale performance of the Korean version of the Berg Balance Scale (BBS). The subjects were 95 elderly people at community dwelling. Subjects (19 men, 76 women) ranged in age from 65 to 91 years. Rasch analysis was then done by means of the Winsteps program to determine the validity and reliability of the Korean version of the BBS evaluation tools for elderly people. The results were as follows: Twenty-one elderly people were excluded for misfit persons. Three items were found to be misfits and the order of item difficulty of the remaining 11 items was arranged. Elderly people BBS ability is indicated by -.94~7.41 logit, and the transformation formula is score=(logit score+.94)/. This transformation formula can be applied to Korean elderly people for balance ability. In the order of difficulty of evaluation items, the most difficult item was "Standing on one foot" and the easiest item was "Standing to Sitting". In conclusion, the Korean version of BBS evaluation tool for the elderly people has been proved valid and will be useful in clinical practice and research in Korea.

재활분야에서 사용하고 있는 평가도구는 대부분 서열척도인 리커트 척도로 구성되어 있다. 이러한 평가도구는 선택된 항목의 난이도 수준이나 분포에 따라 그 결과가 달라질 수 있으므로, 항목에서 획득한 총점을 환자의 기능수준으로 인식하거나 환자간의 능력을 비교하는 것은 제한적이다. 최근에는 서열척도를 등간척도로 변환시켜주고, 객관적으로 평가항목을 분석할 수 있는 문항반응이론의 활용이 대두되고 있다. 문항반응이론에 기초한 라쉬분석은 기존의 서열척도로 구성된 평가항목의 점수를 등간척도로 변환시킨 로짓점수로 항목의 난이도를 알 수 있고, 변환식에서 산출된 환자의 능력점수는 다른 환자와 객관적인 비교가 가능하다. 라쉬분석은 평가도구의 항목선정과 척도분석이 가능하여 평가도구 개발에 활용되고, 환자의 능력추정과 검사동등화를 실시할 수 있어 컴퓨터 개별화 검사(Computerized Adaptive Testing), 문제은행의 항목 제작 등에 사용되고 있다. 본문에서는 라쉬모형에 관한 이론적 배경과 함께 최근 재활분야에서 라쉬분석이 활용된 연구결과를 요약하였다. 현재 재활분야에서 사용하는 기존의 평가도구에 대한 신뢰도와 타당도를 검증하는 연구는 물론, 새로운 평가도구 개발에 라쉬분석이 활용된 연구가 대부분이었다. 평가항목의 단일구성(unidimensionality)정도를 알 수 있는 적합도 검증과 문항의 난이도 분석결과는 환자의 능력에 맞는 과제 및 항목을 선정할 수 있어 중재계획 및 치료에도 도움이 될 수 있다.

The purpose of this study was to validate the Korean version of the Gross Motor Function Measure (GMFM) using Rasch analysis. The data was obtained from the assessments of 59 children with cerebral palsy in Korea and were applied to Rasch's rating scale model to estimate the difficulty and goodness-of-fit of each item. Rasch modeling helped us to identify 76 items from the original 88-item GMFM that form an unidimensional hierarchical scale to rearrange 76 items in order of difficulty. Reliability coefficients of the 88-item and 76-item GMFM were .99 and .99, respectively. In this preliminary report, the Korean version of GMFM seems to have significant validity and reliability. These results may be useful in assessment of gross motor functions in children with cerebral palsy.