具備良好反應性之條件： for 評估工具

具備反應性的前提是：良好的效度（單向度 & 區辨力）與信度（隨機測量誤差）。
1. 具備區辨力（無 floor & ceiling effects），可區辨不同（欲測量特質）能力者之差異
2. 上述的概念類似於評估工具對於不同能力者之測量標準誤(standard error of measurement)低
3. 評估之工具項目具備單向度

＊ 一般實驗室儀器，大多具備區辨力（尤其是對於特定能力階層者），然而其 SEM 大多不低（甚至很高），故反應性不佳。
＊ 一般量表大多藉由增加量尺或題目以期增加區辨力，然而必須確定各量尺或項目確能呼應個案之能力，而且未與其它項目或量尺重複，否則只是多餘。

有獎徵求圖示，以呈現上述概念！意者請恰老師，事先溝通一下。

祝福 立窈

青壯年時期，任何主要決定都須要「智慧」與「勇氣」

這讓我想起一段著名的祈禱文：

God, grant me the serenity to accept the things I cannot change,
The courage to change the things that I can,
And the wisdom to know the difference.

誠摯 祝福 立窈 的決定：一帆風順！

記憶力測驗之類型

J Clin Exp Neuropsychol. 2012;34(2):135-50.

Variety of Memory Measures

合作機構之研究計畫申請

2013 合作機構之研究計畫申請

機構	時間	金額及備註
松德（衛生局統籌款自行研究計畫）	1月初構想書 3月中計畫書與修正表（通知）4月中旬上網遞交	可聘研究助理 2013 申請2件
松德（院內預定研究計畫）	7月下旬構想書； 9月中計畫書與修正表 11月初IRB （12月底IRB通過含）	10萬元以內 2013 申請3件
中山—奇美	7月下旬	可聘研究助理 50萬 2012 申請/通過1件 2013 申請/通過2件
桃療（院內計畫）	隨時可申請	2013 申請1件
桃療（衛生署計畫）	8月初	50萬以內，但人事費用不超過1/3 2013 申請1件
義大	8月底	30萬元之內 2012 申請/通過4件 2013 申請2件
新店慈濟	8月底	20萬元之內 2013 申請1件

＊臺大醫院也有類似「院內」或「院外」合作計畫，金額可達100萬，但因為只能申請耗材，因此實用（申請）價值有限。

＊還有澄清醫院。。。

COSMIN 網站及相關文獻：評論（健康相關）評估工具之標準

侯醫師分享 COSMIN 網站：www.cosmin.nl
COSMIN 計畫之目的為建構評論（健康相關）評估工具之標準
主要由 Dr. Terwee 主持，研究生 Mokkink 執行。
侯醫師別提到 COSMIN 的第1項標準為判斷項目是否符合 reflective model.
因為多數工具發展者並不聲明（或依據）那個 model, 只能自行判斷。
網站上寫著：
"A reflective model is a model in which all items are a manifestation of the same underlying construct. These kind of items are called effect indicators. These items are expected to be highly correlated and interchangeable.
Its counterpart is a formative model, in which the items together form the construct. These items do not need to be correlated. Therefore, internal consistency is not relevant for items that form a formative model. For example, stress could be measured by asking about the occurrence of different situations and events that might lead to stress, such as job loss, death in a family, divorce etc. These events do not need to be correlated, thus internal consistency is not relevant for such an instrument."

COSMIN 計畫詳參考文獻 8，主要成果詳參考文獻 5-7。

1.         Angst, F., The new COSMIN guidelines confront traditional concepts of responsiveness. BMC Med Res Methodol. 2011;11:152; author reply

2.         Terwee, C.B., L.B. Mokkink, D.L. Knol, R.W. Ostelo, L.M. BouterH.C. de Vet, Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Qual Life Res. 2012;21(4):651-7.

3.         Thorborg, K., P. Holmich, R. Christensen, J. PetersenE.M. Roos, The Copenhagen Hip and Groin Outcome Score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med. 2011;45(6):478-91.

4.         Mokkink, L.B., C.B. Terwee, E. Gibbons, P.W. Stratford, J. Alonso, D.L. Patrick, et al., Inter-rater agreement and reliability of the COSMIN (COnsensus-based Standards for the selection of health status Measurement Instruments) checklist. BMC Med Res Methodol. 2010;10:82.

5.         Mokkink, L.B., C.B. Terwee, D.L. Patrick, J. Alonso, P.W. Stratford, D.L. Knol, et al., The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63(7):737-45.

6.         Mokkink, L.B., C.B. Terwee, D.L. Knol, P.W. Stratford, J. Alonso, D.L. Patrick, et al., The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol. 2010;10:22.

7.         Mokkink, L.B., C.B. Terwee, D.L. Patrick, J. Alonso, P.W. Stratford, D.L. Knol, et al., The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010;19(4):539-49.

8.         Mokkink, L.B., C.B. Terwee, D.L. Knol, P.W. Stratford, J. Alonso, D.L. Patrick, et al., Protocol of the COSMIN study: COnsensus-based Standards for the selection of health Measurement INstruments. BMC Med Res Methodol. 2006;6:2.

depression & anxiety CAT 的最新發展--2012 & 2013

2013 Prof. Robert D. Gibbons 又發表 anxiety CAT  了！

Gibbons RD, Weiss DJ, Pilkonis PA, Frank E, Moore T, Kim JB, Kupfer DJ. Development of the CAT-ANX: A Computerized Adaptive Test for Anxiety. Am J Psychiatry. 2013 Aug 9. doi: 10.1176/appi.ajp.2013.13020178. [Epub ahead of print]

跟之前他的團隊發展之 depression CAT 加起來之效能更強大了！！

Aug. 21, 2013 颱風假看到：
Gibbons RD, Hooker G, Finkelman MD, Weiss DJ, Pilkonis PA, Frank E, Moore T, Kupfer DJ. The Computerized Adaptive Diagnostic Test for Major Depressive Disorder (CAD-MDD): a screening tool for depression. J Clin Psychiatry. 2013 Jul;74(7):669-74.

主要結果為：An average of 4 items per participant was required (maximum of 6 items). Overall sensitivity and specificity were 0.95 and 0.87, respectively. For the PHQ-9, sensitivity was 0.70 and specificity was 0.91.

發展 depression 的 screening CAT 這是良好 depression item bank 的必然趨勢（由繁到簡，容易！）

以下是2012 Nov. 的 post:
Gibbons RD, Weiss DJ, Pilkonis PA, Frank E, Moore T, Kim JB, Kupfer DJ. Development of a computerized adaptive test for depression.Arch Gen Psychiatry. 2012 Nov 1;69(11):1104-12.

Rationale:
Unlike other areas of medicine, psychiatry is almost entirely dependent on patient report to assess the presence and severity of disease; therefore, it is particularly crucial that we find both more accurate and efficient means of obtaining that report.

看來 psych 也是最好運用 CAT 的領域。

竟然跟 PROMIS 對打！！

The National Institutes of Health–funded PROMIS initiative has also studied patient-reported outcomes using CAT and IRT, including depression. The primary differences between PROMIS and the CAT-DI for the measurement of depression are (1) the PROMIS item bank consists of 28 items, whereas the CAT-DI bank consists of 389 items; (2) PROMIS has relied on unidimensional IRT models, whereas the CAT-DI incorporates multidimensionality produced by the sampling of items from distinct subdomains of depression; and (3) the CAT-DI has been developed for measuring the severity of depression and screening for depression, whereas PROMIS has focused on measurement of depressive severity.

Funding/Support: This work was supported by grant R01-MH66302 from the National Institute of Mental Health. 

PROMIS 的 depression CAT & CAT-DI 皆是美國政府 support. 看來美國不是內亂就是要打內戰了。。。

Additional Information: The CAT-DI will ultimately be made available for routine administration, and its development as a commercial product is under consideration.
PROMIS 的 CAT 可是免費的！！

Publications of the PROMIS depression CAT

Pilkonis PA, Choi SW, Reise SP, Stover AM, Riley WT, Cella D. PROMISCooperative Group.  Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): depression, anxiety, and anger.  Assessment. 2011;18(3):263-283.
Teresi JA, Ocepek-Welikson K, Kleinman M, Eimicke JP, Crane PK, Jones RN, Lai JS, Choi SW, Hays RD, Reeve BB, Reise SP, Pilkonis PA, Cella D. Analysis of differential item functioning in the depression item bank from the Patient-Reported Outcomes Measurement Information System (PROMIS): an item response theory approach.  Psychol Sci Q. 2009;51(2):148-180.

修改進行中 stroke knowledge 測驗與衛教之設計

因應前一 post 所提「疾病知識」之最下層向度必須依據 reflective model 建構項目(符合單向度以及階層性)
目前進行中之 stroke knowledge & OT knowledge  之測驗與衛教設計，我們必須檢視最下層向度能否設計符合 reflective model 之項目，否則屆時發展出的測驗將難以符合心理計量驗證。

另外各向度內容也必須符合個案/家屬之需求，否則個案之接受度必然低落。

因此我們必須重新檢視stroke knowledge & OT knowledge 之架構，修改部分研究流程！！

以 stroke knowledge 研究流程為例說明：
1. 團隊內部先確認中風衛教內容之初步架構（可依據 1.衛教內容[如中風健康識能衛教三階段架構]及2.發病階段建構之（預計2～4層次））[預計2週左右]
1.a. 測驗部分需思考「各向度之項目符合單向度且有階層性（難易度）」[這也是最低階架構（層次）必須擁有之特質]
   以上請怡靜主負責/富達協助之，原怡靜負責建構衛教內容之投入時間可至少減半。

2. 尋求「專家」的看法以修改確認之（先訪談[每次1~2位專家]再以問卷確認）

3. 以初步架構確認「個案/家屬」之需求（先訪談再以問卷確認）

4. 彙整/發表論文

Note:
1. 個案/家屬之「知識」需求與個案所處階段（發病後階段）、社經地位、健康識能相關。
2. 訪談個案/家屬宜由慢性個案/家屬開始，因為他們已有最多經歷，可以訪談的內容最豐富。
3. 由於我們團隊對此研究主題，仍在摸索的階段，造成研究流程不斷修改。這有點無奈，卻是「從無到有，由淺入深」的必經過程。也就是任何研究題材深入過程中，必經（不斷修改[改革/創新]）之階段！