Assessment of the factorial validity and reliability of the ALSFRS-R: a revision of its measurement model
The amyotrophic lateral sclerosis functional rating scale-revised (ALSFRS-R) is a widely used primary outcome measure in amyotrophic lateral sclerosis (ALS) clinical practice and clinical trials. ALSFRS-R items cannot, however, validly be summed to obtain a total score, but constitute domain scores...
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Published in | Journal of neurology Vol. 264; no. 7; pp. 1413 - 1420 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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Berlin/Heidelberg
Springer Berlin Heidelberg
01.07.2017
Springer Nature B.V |
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Abstract | The amyotrophic lateral sclerosis functional rating scale-revised (ALSFRS-R) is a widely used primary outcome measure in amyotrophic lateral sclerosis (ALS) clinical practice and clinical trials. ALSFRS-R items cannot, however, validly be summed to obtain a total score, but constitute domain scores reflecting a profile of disease severity. Currently, there are different measurement models for estimating domain scores. The objective of the present study is, therefore, to derive the measurement model that best fits the data for a valid and uniform estimation of ALSFRS-R domain scores. Data from 1556 patients with ALS were obtained from a population-based register in The Netherlands. A random split of the sample provided a calibration and validation set. Measurement models of the ALSFRS-R were investigated using both exploratory factor analyses and confirmatory factor analyses. The measurement model with a four-factor structure (i.e., bulbar, fine motor, gross motor, and respiratory function), with correlated factors and cross-loading items on dressing and hygiene and turning in bed and adjusting bed clothes on both motor function scales, provided the best fit to the data in both sets. Correlation between factors ranged from weak to modest, confirming that the ALSFRS-R constitutes a profile of four clinically relevant domain scores rather than a total score that expresses disease severity. The internal consistency of the four domain scores was satisfactory. Our revision of the measurement model may allow for a more adequate estimation of disease severity and disease progression in epidemiological studies and clinical trials. |
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AbstractList | The amyotrophic lateral sclerosis functional rating scale-revised (ALSFRS-R) is a widely used primary outcome measure in amyotrophic lateral sclerosis (ALS) clinical practice and clinical trials. ALSFRS-R items cannot, however, validly be summed to obtain a total score, but constitute domain scores reflecting a profile of disease severity. Currently, there are different measurement models for estimating domain scores. The objective of the present study is, therefore, to derive the measurement model that best fits the data for a valid and uniform estimation of ALSFRS-R domain scores. Data from 1556 patients with ALS were obtained from a population-based register in The Netherlands. A random split of the sample provided a calibration and validation set. Measurement models of the ALSFRS-R were investigated using both exploratory factor analyses and confirmatory factor analyses. The measurement model with a four-factor structure (i.e., bulbar, fine motor, gross motor, and respiratory function), with correlated factors and cross-loading items on dressing and hygiene and turning in bed and adjusting bed clothes on both motor function scales, provided the best fit to the data in both sets. Correlation between factors ranged from weak to modest, confirming that the ALSFRS-R constitutes a profile of four clinically relevant domain scores rather than a total score that expresses disease severity. The internal consistency of the four domain scores was satisfactory. Our revision of the measurement model may allow for a more adequate estimation of disease severity and disease progression in epidemiological studies and clinical trials. |
Author | Schröder, Carin D. Visser-Meily, Johanna M. A. Bakker, Leonhard A. Westers, Paul van Es, Michael A. van den Berg, Leonard H. |
Author_xml | – sequence: 1 givenname: Leonhard A. orcidid: 0000-0001-5221-5095 surname: Bakker fullname: Bakker, Leonhard A. organization: Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Centre of Excellence for Rehabilitation Medicine, Brain Centre Rudolf Magnus, University Medical Centre Utrecht and De Hoogstraat Rehabilitation – sequence: 2 givenname: Carin D. surname: Schröder fullname: Schröder, Carin D. organization: Centre of Excellence for Rehabilitation Medicine, Brain Centre Rudolf Magnus, University Medical Centre Utrecht and De Hoogstraat Rehabilitation, Department of Rehabilitation, Physical Therapy Science, and Sports Medicine, Brain Centre Rudolf Magnus, University Medical Centre Utrecht – sequence: 3 givenname: Michael A. orcidid: 0000-0002-7709-5883 surname: van Es fullname: van Es, Michael A. organization: Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht – sequence: 4 givenname: Paul surname: Westers fullname: Westers, Paul organization: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht – sequence: 5 givenname: Johanna M. A. surname: Visser-Meily fullname: Visser-Meily, Johanna M. A. organization: Centre of Excellence for Rehabilitation Medicine, Brain Centre Rudolf Magnus, University Medical Centre Utrecht and De Hoogstraat Rehabilitation, Department of Rehabilitation, Physical Therapy Science, and Sports Medicine, Brain Centre Rudolf Magnus, University Medical Centre Utrecht – sequence: 6 givenname: Leonard H. orcidid: 0000-0002-5203-9674 surname: van den Berg fullname: van den Berg, Leonard H. email: L.H.vandenBerg@umcutrecht.nl organization: Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht |
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Keywords | Confirmatory factor analysis Amyotrophic lateral sclerosis Amyotrophic lateral sclerosis functional rating scale-revised |
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SubjectTerms | Activities of Daily Living Amyotrophic lateral sclerosis Amyotrophic Lateral Sclerosis - diagnosis Amyotrophic Lateral Sclerosis - physiopathology Clinical trials Deglutition Factor Analysis, Statistical Female Humans Male Medicine Medicine & Public Health Middle Aged Motor Activity Motor task performance Neurology Neuroradiology Neurosciences Original Communication Reproducibility of Results Respiration Respiratory function Speech Surveys and Questionnaires Validation studies |
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Title | Assessment of the factorial validity and reliability of the ALSFRS-R: a revision of its measurement model |
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