Trudy Mallinson, PhD, OTR/L, NZROT, FAOTA

Assistant Professor of Occupational Science and Occupational Therapy

Room: CHP 133
Phone: (323) 442-2950
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Biography

Trudy Mallinson is well known for her work in the areas of instrument development, outcomes measurement, and post-acute care health services research. She received her occupational therapy training in New Zealand, later earning a Bachelor in Psychology from the University of Canterbury. After moving to the U.S. she received her Master's degree in Occupational Therapy and her PhD in Public Health from the University of Illinois at Chicago. She completed a postdoctoral fellowship in health services research and health policy studies at Northwestern University. In 2012 she was named to the Roster of Fellows of the American Occupational Therapy Association (AOTA).
 
Dr. Mallinson has particular expertise in developing and refining assessments that measure health care outcomes. In particular, she is skilled in the application of item response theory (Rasch analysis). Additionally, she has expertise in examining and using Medicare administrative and assessment data to examine post-acute care rehabilitation outcomes. Her work has been funded by NIDRR, CMS, and NIH.
 
She currently serves as a consultant on Medicare projects examining post-acute care outcomes and access across post-acute care settings. She is also a representative for AOTA on a number of health care quality initiatives including Physician Consortium on Performance Improvement (PCPI) and the Medicare Payment Advisory Commission (MEDPAC). Dr. Mallinson is known internationally for her service to The Joanna Briggs Institute, where she serves as a collaborator and expert in the development of evidence-based practice guidelines for occupational therapy.

Research Interests

Dr. Mallinson’s research interests are concentrated around the investigation of the quality of rehabilitation care, patient outcomes, and the improvement of rehabilitation outcome measures as they relate to informing health policy.

Education

Doctor of Philosophy (Ph D) in Public Health
University of Illinois Health Science
2000

Master of Science (MS) in Occupational Therapy
University of Illinois Health Science
1994

Bachelor of Science (BS) in Psychology
1989

Publications

Book Chapters

Heinemann, A., & Mallinson, T. (2007). Functional status and quality-of-life measures. In Frank, R. G., & Elliott, T. R. (Eds.), Handbook of Rehabilitation Psychology. Washington DC: American Psychological Association.

Mallinson, T. (2006). Activities of daily living. In G. Albrecht (Ed.), Encyclopedia of Disability. Thousand Oaks, CA: Sage Publications.

Mallinson, T., & Cella, D. (2004). Fatigue and everyday function in people living with cancer. In Armes, J., Krishnasamy, M., & Higginson, I. (Eds.), Fatigue in Cancer. London: Oxford University Press.

Journal Articles

Fitzgerald, C. M., & Mallinson, T. (2012). The association between pelvic girdle pain and pelvic floor muscle function in pregnancy. International Urogynecology Journal, 23, 893-898. doi:10.1007/s00192-011-1658-y. Abstract →← Abstract 

INTRODUCTION AND HYPOTHESIS: The aim of this study is to determine pelvic floor muscle (PFM) function in second trimester women with and without pelvic girdle pain (PGP).
 
METHODS: Fifty-five pregnant women with and without PGP were recruited in the second trimester who met inclusion for self-reported pain. Vaginal examination was performed assessing superficial and deep PFM tenderness, contract/relax patterns, and muscle strength.
 
RESULTS: Fifty-one patients (26 with PGP and 25 without) were included in the final analyses. Significantly more patients in the PGP group had bilateral levator ani and obturator internus tenderness compared with the no pain group (Fisher's exact test (FET) P < 0.001). No other significant group differences were found.
 
CONCLUSION: There is an association between PGP and deep but not superficial PFM tenderness in pregnancy. Lack of accompanying PFM dysfunction in PGP during pregnancy may reflect pain duration.

Fitzgerald, C. M., Santos, L. R., & Mallinson, T. (2012). The association between pelvic girdle pain and urinary incontinence among pregnant women in the second trimester. International Journal of Gynecology & Obstetrics, 117, 248-250. doi:10.1016/j.ijgo.2012.01.014. Abstract →← Abstract 

OBJECTIVE: To examine the association among pelvic girdle pain (PGP), urinary incontinence (UI), and pelvic floor muscle (PFM) function in pregnant women in the second trimester.
 
METHODS: Fifty-five pregnant women (29 with PGP and 26 without) were enrolled. Urinary incontinence was measured via the International Consultation on Incontinence Questionnaire-Short Form. Vaginal examination assessed PFM contract-relax patterns and muscle strength.
 
RESULTS: Overall, 51 women (26 with PGP and 25 without) were included in the final analyses. After controlling for PFM muscle strength, women with PGP were significantly more likely to have UI (P=0.03). After controlling for pain status, having little or no PFM contraction was significantly associated with UI (P=0.03). There was no association between PGP and PFM weakness.
 
CONCLUSION: There was an association between PGP and UI and between UI and PFM weakness among the study participants. Lack of PFM weakness in women with PGP during pregnancy may reflect acuity of pain or measurement error.

Neville, C. E., Fitzgerald, C. M., Mallinson, T., Badillo, S., Hynes, C., & Tu, F. (2012). A preliminary report of musculoskeletal dysfunction in female chronic pelvic pain: A blinded study of examination findings. Journal of Bodywork and Movement Therapies, 16, 50-56. doi:10.1016/j.jbmt.2011.06.002. Abstract →← Abstract 

INTRODUCTION AND HYPOTHESIS: Female chronic pelvic pain is prevalent and causes disability. Can women with self-reported chronic pelvic pain (CPP) be distinguished from pain-free women by demonstrating a greater number of abnormal musculoskeletal findings on examination?
 
METHODS: In this cross-sectional study, blinded examiners performed 9 physical exam maneuvers on 48 participants; 19 with CPP, and 29 pain-free. Frequency of positive findings between groups, total number of positive exam findings, cluster analysis, and sensitivity - specificity analyses were performed.
 
RESULTS: Women with CPP presented with significantly more abnormal findings than pain-free women. By using two examination maneuvers, examiners correctly classified women with self-reported CPP from pain-free women 85% of the time.
 
CONCLUSIONS: Abnormal findings on musculoskeletal exam are more common in women with self-reported CPP. Women with CPP might benefit from a faster time to diagnosis and improved treatment outcomes if a musculoskeletal contribution to CPP was identified earlier.

Fitzgerald, C. M., Neville, C. E., Mallinson, T., Badillo, S. A., Hynes, C. K., & Tu, F. F. (2011). Pelvic floor muscle examination in female chronic pelvic pain. Journal of Reproductive Medicine, 56(3-4), 117-122. Abstract →← Abstract 

OBJECTIVE: To determine if women with self-reported chronic pelvic pain (CPP) were more likely to have positive findings on two vaginal pelvic floor muscle (PFM) tests compared to women without CPP when the examiner was blinded to pain status.
 
STUDY DESIGN: This was a prospective, cross-sectional study. Blinded examiners performed two vaginal pelvic floor tests (tenderness and strength) on 48 participants: 19 with self-reported CPP and 29 who were pain-free. Relative frequency of positive findings between groups and the total number of positive physical examination findings were calculated.
 
RESULTS: Women with self-reported CPP were more likely to have PFM tenderness (63.2% with physician [M.D.] examiners [board certified in physical medicine and rehabilitation] and 73.7% with physical therapist [P.T.] examiners) as compared to pain-free participants (Fisher's exact test [FET]), 48 p < 0.001 with M.D., p < 0.001 with P.T.). PFM weakness was not more likely in women with CPP (31.6% with M.D., 42.1% with P.T.) as compared with pain-free participants (48.3% with M.D., 17.2% with P.T.) (FET, 48 p = 0.37 with M.D., p = 0.096 with P.T.).
 
CONCLUSION: PFM tenderness is found more frequently in women with self-reported CPP than in pain-free women. PFM strength did not differentiate CPP from pain-free participants. Improved standardization of the PFM examination across disciplines may be helpful in distinguishing subgroups and treating women with CPP.

Ehrlich-Jones, L., Mallinson, T., Fischer, H., Bateman, J., Semanik, P. A., Spring, B., Ruderman, E., & Chang, R. W. (2010). Increasing physical activity in patients with arthritis: A tailored health promotion program. Chronic Illness, 6(4), 272-281. doi:10.1177/1742395309351243. Abstract →← Abstract 

OBJECTIVE: Despite recent studies showing the benefit of physical activity for people with arthritis, the vast majority of persons with arthritis are not sufficiently physically active. The purpose of this report is to describe a tailored health promotion intervention aimed at increasing physical activity among persons with arthritis. The intervention is designed to be useful for health systems and insurers interested in a chronic disease management program that could be disseminated to large populations of arthritis patients.
 
METHODS: The intervention is carried out by a clinician who is designated as the client's physical activity advocate. The approach emphasizes motivational interviewing, individualized goal setting, tailored strategies for increasing physical activity and for monitoring progress, and a plan of 2 years of follow-up. The intervention includes a standardized assessment of barriers to and strengths supporting increased lifestyle physical activity. A randomized, controlled trial is underway to evaluate the efficacy and cost-effectiveness of this intervention.
 
CONCLUSION: This intervention is unique in that it implements a program tailored to the individual that focuses on lifestyle physical activity and long-term monitoring. The approach recognizes that persons with arthritis present with varying levels of motivation for change in physical activity and that behavior change can take a long time to become habitual.

Dobrez, D., Heinemann, A. W., Deutsch, A., Manheim, L., & Mallinson, T. (2010). Impact of Medicare's prospective payment system for inpatient rehabilitation facilities on stroke patient outcomes. American Journal of Physical Medicine and Rehabilitation, 89(3), 198-204. doi:10.1097/PHM.0b013e3181c9fb40. Abstract →← Abstract 

OBJECTIVE: To estimate the effect of Medicare's prospective payment system for inpatient rehabilitation facilities on discharge functional status, community discharge, and length of stay.
 
DESIGN: Secondary analysis using data drawn from the American Medical Rehabilitation Providers Association subscription database. Eligible patients were Medicare and non-Medicare stroke patients discharged from inpatient rehabilitation facilities from 1998 through the first two quarters of 2006. Random effects panel data models were used to estimate the impact of prospective payment on motor and cognitive discharge function, the probability of discharge to the community and inpatient length of stay, controlling for patient, and facility characteristics.
 
RESULTS: The introduction of prospective payment was associated with small, statistically significant reductions in Functional Independence Measure discharge motor (-1.10) and cognitive (-0.15) scores and in the probability of discharge to the community (adjusted odds ratio: 0.87) for Medicare fee-for-service patients. Length of stay was substantially lower for both Medicare (-1.86 days) and (-2.16) non-Medicare fee-for-service patients.
 
CONCLUSIONS: Further research is needed to determine whether the small reductions in patient function are persistent over time. This short-term evaluation of prospective payment system suggests minimal negative impact on stroke patient function at discharge because of the change in Medicare reimbursement but a decrease in likelihood of discharge to the community.

Mallinson, T., & Fischer, H. (2010). Centennial Vision—Rehabilitation research. American Journal of Occupational Therapy, 64, 506-514. doi:10.5014/ajot.2010.09080.

Mallinson, T., & Hammel, J. (2010). Measurement of participation: Intersecting person, task, and environment. Archives of Physical Medicine & Rehabilitation, 91(9 Suppl), S29-33. Abstract →← Abstract 

The goals of this article are to describe participation as a transaction and issues involved in measuring and intervening using this transactional approach; describe ecologic and systems-based theoretic approaches for conceptualizing person-task-environment transactions; and illustrate examples of an exploratory strategy, radar plots, as a clinical tool for rehabilitation professionals to show this interaction and use it to inform participation-focused interventions with people with disabilities in rehabilitation settings. Participation necessarily occurs at the intersection of what the person can do, wants to do, has the opportunity to do, and is not prevented from doing. It is a transaction that occurs at the nexus of the person-task-environment. Measurement of participation should capture this transactive nature. Radar plots are part of a group of graphic displays frequently referred to as exploratory data analysis. In situations in which theory is not well developed, exploratory techniques such as radar plots may hold promise as ways to explore better the relationship among variables. This article describes strengths and limitations of radar plots and presents an example with data from the Community Participation Database.

Mallinson, T., Fischer, H., Rogers, J., Ehrlich-Jones, L., & Chang, R. (2009). The issue is—Human occupation for public health promotion: New directions for occupational therapy practice with persons with arthritis. American Journal of Occupational Therapy, 63, 220-226. doi:10.5014/ajot.63.2.220. Abstract →← Abstract 

Health promotion has been described as "the process of enabling people to increase control over, and to improve, their health" (World Health Organization, 1986). It is one of the five intervention approaches of the Occupational Therapy Practice Framework (American Occupational Therapy Association [AOTA], 2002, 2008). As early as the 1970s, there were calls for occupational therapy to become active in health promotion (Brunyate Weimer, 1972). More recently, AOTA articulated a role for occupational therapists in health promotion (AOTA Commission on Practice, 2001), charging practitioners to promote health and wellness in both individuals and communities through engagement in human occupation to promote healthy lifestyles. Occupational therapy practice traditionally focuses on individuals, but to evaluate the impact of occupational therapy health promotion programs, the profession will need to assume a greater public health focus. This article presents the thesis that a public health focus is needed to facilitate wider adoption of health promotion practices in the profession.

Gage, B., Stineman, M., Deutsch, A., Mallinson, T., Heinemann, A., Bernard, S., & Constantine, R. (2007). Perspectives on the state-of-the-science in rehabilitation medicine and its implications for Medicare postacute care policies. Archives of Physical Medicine and Rehabilitation, 88, 1737-1739. doi:10.1016/j.apmr.2007.09.025. Abstract →← Abstract 

Better measurement of the case-mix complexity of patients receiving rehabilitation services is critical to understanding variations in the outcomes achieved by patients treated in different postacute care (PAC) settings. The Medicare program recognized this issue and is undertaking a major initiative to develop a new patient-assessment instrument that would standardize case-mix measurement in inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home health agencies. The new instrument, called the Continuity Assessment Record and Evaluation Tool, builds on the scientific advances in measurement to develop standard measures of medical acuity, functional status, cognitive impairment, and social support related to resource need, outcomes, and continuity of care for use in all PAC settings.

Elliott, D. B., Pesudovs, K., & Mallinson, T. (2007). Vision-related quality of life [Guest editorial]. Optometry and Vision Science, 84, 656-658. doi:10.1097/OPX.0b013e31814db01e.

Mallinson, T. (2007). Why measurement matters when measuring patient vision outcomes. Optometry and Vision Science, 84, 675-682. doi:10.1097/OPX.0b013e3181339f44. Abstract →← Abstract 

Optometrists, by definition, care deeply about measurement. This brief review article considers the essential features of measurement that make many optometric instruments so useful and how patient-centered survey instruments such as vision-related quality of life questionnaires, can be analyzed using contemporary psychometric methods, so that they also conform to these essential features of measurement. These features include unidimensionality, hierarchical order, and equal interval scaling. Optometrists demand these features because they need to make meaningful comparisons both between patients and over time. Questionnaires about visual function or health-related quality of life, typically involve a series of rating scale type items that are added up to produce a total raw score. Yet total raw scores, which are ordinal, do not exhibit the essential properties of measurement. The Rasch Model, developed by Georg Rasch in 1956, converts ordinal-level raw score data into interval measures that demonstrate the essential features of measurement. Under the Rasch model any obtained score (response) is conceptualized as the difference between the amount of a trait reflected in an item, i.e., how hard the item is, and the ability of the person responding to the item. The Rasch model estimates the log odds probability (logit) for any response by any person. Logits are equal interval, representing equal amounts of the construct being measured across the entire range of the construct. Logits define the hierarchical order of items, how hard or easy items are, and the Rasch model specifies that this order of items must be invariant for all persons, that is, must be unidimensional. There are numerous software packages available for applying the Rasch model, all provide methods for evaluating how well data demonstrate unidimensionality, hierarchical order, and equal interval scaling. These can be used in the development, assessment or revision of questionnaires to optimize measurement.

Mallinson, T., Cella, D., Cashy, J., & Holzner, B. (2006). Giving meaning to measure: Linking self-reported fatigue and function to performance of everyday activities. Journal of Pain & Symptom Management, 31, 229-241. doi:10.1016/j.jpainsymman.2005.07.012. Abstract →← Abstract 

Fatigue, a common symptom of cancer patients, particularly those on active treatment, is generally evaluated using self-report methods, yet it remains unclear how self-reported fatigue scores relate to performance of daily activities. This study examines the relationships among self-reported and performance-based measures of function in patients receiving chemotherapy (CT) to link self-reported fatigue measures to self-report and performance-based measures of function. Self-reported fatigue using the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F) and self-reported physical function using the physical function 10 subscale of the Short Form 36 (SF-36) (PF-10) were measured in 64 patients within 2 weeks of beginning CT (n = 64) and after three cycles of CT (n = 48). Motor and cognitive functions were captured using five self-reported and seven observed-performance measures at each time point. Significant correlations between self-reported and observed measures ranged from 0.30 to 0.71. Self-reported fatigue correlated (0.30–0.45) with performance-based function. FACIT-F scores in the range of 30 and below and PF-10 scores in the range of 50 and below were related to an increased difficulty performing everyday activities. Observed measures of physical performance correlate moderately with self-reported fatigue and self-reported physical function. These relationships enable one to begin linking fatigue scores directly to a person's ability to perform everyday activities.

Finlayson, M., Mallinson, T., & Barbossa, V. M. (2005). Activities of daily living (ADL) and instrumental activities of daily living (IADL) items were stable over time in a longitudinal study on aging. Journal of Clinical Epidemiology, 58, 338-349. doi:10.1016/j.jclinepi.2004.10.008. Abstract →← Abstract 

OBJECTIVE: The purpose of this analysis was to examine the stability over time of the activities of daily living (ADL) and instrumental activities of daily living (IADL) items in the Aging in Manitoba (AIM) Longitudinal Study and to evaluate the existence of differential item functioning across settings (home, nursing home).
 
STUDY DESIGN AND SETTING: The study used data from 607 participants of the AIM Longitudinal Study who were more than 85 years of age in 1996 and who had complete data from 1983, 1990, and 1996 for all ADL and IADL items. Rasch analysis was used to examine how the rating scale of the ADL and IADL items was used by participants, and to determine if the ordering of items remained stable across three time periods (1983, 1990, 1996) and the two different settings (home, nursing home).
 
RESULTS: The rating scale worked best when dichotomized into “received no assistance” and “receives assistance.” Except for four items (making tea, making meals, doing nursing care, and going outside in any weather), the items were stable across administration periods, and across settings.
 
CONCLUSION: The AIM can be used to evaluate changes in disability over time and may have the potential to identify those at risk for transitions in care.

Chen, C. C., Heinemann, A. W., Bode, R. K., Granger, C. V., & Mallinson, T. (2004). Impact of pediatric rehabilitation services on children’s functional outcomes. American Journal of Occupational Therapy, 58, 44-53. doi:10.5014/ajot.58.1.44. Abstract →← Abstract 

OBJECTIVES: Relatively little is known about the treatment effectiveness and functional outcomes of pediatric rehabilitation therapies. This study was conducted to gain knowledge of the type and quantity of inpatient rehabilitation services provided to children who received acute inpatient rehabilitation and compare functional gains by age and diagnosis.
 
METHOD: A retrospective cohort design was used. Records of rehabilitation therapies and functional assessments of 814 pediatric patients who received inpatient rehabilitation during 1996, 1997, and 1998 were collected. The admission and discharge item ratings of the WeeFIM® instrument were first transformed into interval- level measures of self-care, mobility, and cognition. Parametric analyses were used to compare functional gains across impairment groups and to examine the relationship between amount of treatment and functional gains.
 
RESULTS: Occupational therapy and physical therapy were the primary rehabilitation services received by patients across impairment groups (98% and 99%, respectively). A large proportion of children with traumatic brain injuries also received speech therapy (97%) and psychology services (60%). Across domains (selfcare, mobility, cognition), the largest gains were made by children who were older than 7 years and had traumatic injuries. Functional gains were significantly related to the amount of discipline-specific treatment received, after controlling for age, impairment, and functional status at admission.
 
CONCLUSION: Rehabilitation therapy provision in pediatric inpatient rehabilitation varies greatly depending on children’s age and the nature of the impairment. Systematic reporting of type and quantity of rehabilitation therapies along with functional assessments before and after hospitalization would allow researchers to track functional changes and study the determinants of functional improvement.

Bode, R. K., Heinemann, A. W., Semik, P., & Mallinson, T. (2004). Relative importance of rehabilitation therapy characteristics on functional outcomes for persons with stroke. Stroke, 35, 2537-2542. doi:10.1161/​01.STR.0000145200.02380.a3. Abstract →← Abstract 

BACKGROUND AND PURPOSE: The purpose of this study was to evaluate the relative importance of therapy focus, intensity, and length of stay on greater than expected functional gain, controlling for stroke severity.
 
METHODS: This observational study included 198 first-stroke patients who were recruited from 8 in-patient rehabilitation facilities and 5 subacute programs. Stroke severity (motor, sensory and cognitive impairment) at admission was measured using an instrument combining all 3 aspects; self-care, mobility, and cognitive status at admission and discharge were measured with the Functional Independence Measure. Time spent by physical, occupational, and speech-language therapists on function- and impairment-focused activities were used to compute therapy intensity by discipline and type of activity. Residual change scores, estimated by regressing discharge on admission functional status, were modeled using patient and therapy characteristics.
 
RESULTS: Controlling for the stroke severity, greater than expected gains in self-care were predicted by longer lengths of stay and more intensive function-focused occupational therapy, and greater than expected cognitive gains were predicted by longer stays alone. Predictors of residual change in mobility, however, differed by gender: greater than expected gains in mobility for men were predicted by longer lengths of stay and more intense function-focused physical therapy whereas, for women, they were predicted by stroke severity alone.
 
CONCLUSIONS: Unlike previous studies using raw functional gains, therapies accounted for a significant proportion of the variance in residual functional change. The results support studies suggesting that both content and amount of therapy are important aspects.

Bode, R. K., Heinemann, A. W., Semik, P., & Mallinson, T. (2004). Patterns of therapy activities across length of stay and impairment levels: Peering inside the "black box" of inpatient stroke rehabilitation. Archives of Physical Medicine and Rehabilitation, 85, 1901-1908. doi:10.1016/j.apmr.2004.02.023. Abstract →← Abstract 

OBJECTIVES: To classify therapy activities and to describe the type and pattern of activities provided during inpatient rehabilitation to persons with stroke.
 
DESIGN: Descriptive study.
 
SETTING: Eight acute and 5 subacute rehabilitation facilities across the United States.
 
PARTICIPANTS: Persons with stroke (N=177) who received rehabilitation services and had lengths of stay (LOSs) between 2 and 5 weeks.
 
INTERVENTIONS: Not applicable.
 
MAIN OUTCOMES MEASURES: Weekly and total therapy units aggregated by discipline and activity type for each of 4 (2-wk, 3-wk, 4-wk, 5-wk) LOS groups.
 
RESULTS: Across LOS groups, significant differences in total therapy units were found by week of rehabilitation, discipline, and therapy activity type. Patterns in and significant interactions of time and activity type by discipline were also found. The amount of therapy provided by occupational and physical therapists was significantly more than that provided by speech-language pathologists.
 
CONCLUSIONS: Patterns of time spent in therapy are similar for all LOS groups, but type of therapy received reflects a complex interaction of patient severity, rehabilitation discipline, and LOS.

Mallinson, T., Stelmack, J., & Velozo, C. (2004). A comparison of the separation ratio and coefficient alpha in the creation of minimum item sets. Medical Care, 42(1 Suppl), I17-24. doi:10.1097/01.mlr.0000103522.78233.c3. Abstract →← Abstract 

BACKGROUND: Short-form outcomes measures are becoming common in response to demands for increased efficiency in health care. This study examines Rasch measurement as an aid to selecting items for short form tests. The focus of this paper is on maintaining test quality while reducing items. The separation ratio (SR) aids item reduction by indicating how removing items impacts measurement precision. Results of the SR and coefficient alpha are compared.
 
OBJECTIVES: To demonstrate the use of Rasch measurement to shorten clinical outcomes measures and to compare the separation ratio and coefficient alpha in evaluating when item reduction improved efficiency without sacrificing measurement precision.
 
RESEARCH DESIGN: Retrospective analysis of existing health outcomes data.
 
SUBJECTS: A convenience sample of 58 patients receiving cataract surgery. MEASURES: The 14 items of the VF-14 (a measure of visual functioning), the published subset of items from this test (the VF-7), and 5 other 7-item combinations of the items. RESULTS: The largest coefficient alpha was obtained from the VF14 (.84) while the largest separation ratio (2.67) was obtained from the 7-item subtest with the reduced rating scale.
 
CONCLUSIONS: This study demonstrated one way that Rasch measurement can be helpful in selecting items for minimum item sets while maintaining test precision. Both alpha and the separation ratio provide information about how a sample performed with a given test although variations in measurement precision may not always be detected with alpha.

Kielhofner, G., Mallinson, T., Forsyth, K., & Lai, J. S. (2001). Psychometric properties of the second version of the Occupational Performance History Interview (OPHI-II). American Journal of Occupational Therapy, 55, 260-267. doi:10.5014/ajot.55.3.260. Abstract →← Abstract 

OBJECTIVE: This study examined the validity of the Occupational Identity, Occupational Competency, and Occupational Behavior Settings scales of the second version of the Occupational Performance History Interview (OPHI-II). The study also asked whether the scales' items were targeted to and could effectively discriminate between persons at different levels of adaptation.
 
METHOD: Data were collected from 151 raters on 249 subjects from eight countries and in six languages. Many-faceted Rasch analysis was used to analyze the data.
 
RESULTS: The items of each scale worked effectively to measure the underlying construct for which they were designed. All three scales validly measured more than 90% of the subjects, who varied by nationality, culture, age, and diagnostic status. Each scale's items were appropriately targeted to the subjects, and all three scales distinguished subjects into approximately three different levels. More than 90% of the raters used the three scales validly and had approximately the same degree of severity or leniency. The scales were valid across subjects with physical dysfunction and psychiatric conditions as well as subjects with no active diagnosed condition.
 
CONCLUSION: The three scales of the OPHI-II are valid across age, diagnosis, culture, and language and effectively measure a wide range of persons. Raters can readily use the OPHI-II validly without formal training.

Velozo, C. A., Lai, J. S., Mallinson, T., & Hauselman, E. (2000). Maintaining instrument quality while reducing items: Application of Rasch analysis to a self-report of visual function. Journal of Outcome Measurement, 4, 667-680. Abstract →← Abstract 

While efficiency has been of concern in the measurement of health care outcomes, little attention has been devoted to methods that achieve efficient, shortened instruments that have good psychometric properties. The purpose of this study was to show how Rasch analysis could be used to reduce the number of items in an instrument while maintaining credible psychometric properties. This approach was applied to the Visual Function-14 (VF-14), a self-report of 14 vision-dependent activities, designed to measure the need for and outcomes of cataract surgery. An instrument which contained the VF-14 plus an additional 10 items that were developed for the study (VF-24) was administered to sixty-one patients (73.7+/-9.5 years) about to undergo extracapsular cataract removal at one of two surgical centers. Rasch analysis (BIGSTEPS) of the VF-14 showed a number of limitations to the original instrument, including: 1) unequal use of the five rating categories, 2) ceiling effect, 3) several other gaps where patient abilities did not match with item difficulties, and 4) sets of items that appeared redundant, (i.e., having the same calibration level). To resolve the first three of these problems, the rating scale was converted to a three-point scale and BIGSTEPS was run with all 24 items. (10 additional items added to the VF-14 designed to "fill in" the gaps). The conversion to a three-point scale and the increase in items resulted in some improvement in the matching of item difficulty to patient ability, as evidenced by a slight decrease in gaps. The addition of items resulted in improvements in person separation (2.55 to 2.99) and Cronbach's alpha (.83 to .91) but did not substantially reduce the ceiling effect and furthermore resulted in an increase in item redundancy. The final practical improvement undertaken was to reduce the number of items while attempting to maintain the psychometric qualities of the instrument as a whole. Three criteria were used in deciding to remove items: 1) high mean square, 2) low mean square and 3) items having similar calibrations. In addition, if an analysis showed that the removal of an item substantially decrease person separation, that item was retained for further analyses. Relative to the original VF-14, the resulting VF-10 showed less redundancy of items while person separation (2.20) and Cronbach's alpha (.89) remained relatively intact. The study demonstrates that Rasch analysis, while effective in elucidating the metrics of an original instrument, can also be useful in designing modifications of instruments that are both efficient and psychometrically sound.

Mallinson, T., Mahaffey, E., & Kielhofner, G. (1998). The Occupational Performance History Interview: Evidence for three underlying constructs of occupational adaptation. Canadian Journal of Occupational Therapy, 65(4), 219-228. Abstract →← Abstract 

Data from 20 psychiatric clients were used to test the construct validity of the Occupational Performance History Interview, which gathers information on a person's past and present functioning. The instrument appears to measure three underlying constructs--occupational competence, identity, and environment--rather than occupational adaptation.

Mallinson, T., Kielhofner, G., & Mattingly, C. F. (1996). Metaphor and meaning in a clinical interview. American Journal of Occupational Therapy, 50, 338-346. doi:10.5014/ajot.50.5.338. Abstract →← Abstract 

This study examined the narrative features of 20 life histories gathered from psychiatric patients with the Occupational Performance History Interview. The aim was to identify how narrative features were present in the patient interview responses and to illustrate how such narrative features can be located. We found that the patients organized their interview responses with deep metaphors that served to "emplot, " or give meaning to, the life story. This article illustrates how patients used the deep metaphors to both circumscribe and frame possible solutions to the problems in their lives. Deep metaphors are consistent, recurring images of a life story that give coherence to, and aid in, the interpretation of the events of that life. Moreover, we explored how metaphors can be located in patient life histories and their implications for occupational therapy.