title: Cross-cultural validity of functional independence measure items in stroke: a study using Rasch analysis.
abstract: OBJECTIVE
  To analyse cross-cultural validity of the Functional Independence Measure (FIM) in patients with stroke using the Rasch model.
  
  
  METHODS
  Thirty-one rehabilitation facilities within 6 different countries in Europe.
  
  
  METHODS
  A total of 2546 in-patients at admission, median age 63 years.
  
  
  METHODS
  Data from the FIM were evaluated with the Rasch model, using the Rasch analysis package RUMM2020. A detailed analysis of scoring functions of the 7 categories of the FIM items was undertaken prior to testing fit to the model. Categories were re-scored where necessary. Analysis of Differential Item Functioning was undertaken in pooled data for each of the FIM motor and social-cognitive scales, respectively.
  
  
  RESULTS
  Disordered thresholds were found on most items when using 7 categories. Fit to the Rasch model varied between countries. Differential Item Functioning was found by country for most items. Adequate fit to the Rasch model was achieved when items were treated as unique for each country and after a few country-specific items were removed.
  
  
  CONCLUSIONS
  Clinical collected data from FIM for patients with stroke cannot be pooled in its raw form, or compared across countries. Comparisons can be made after adjusting for country-specific Differential Item Functioning, though the adjustments for Differential Item Functioning and rating scales may not generalize to other samples.
authors.affiliation: Rehabilitation medicine, Sahlgrenska Academy at Göteborg University, Sahlgrenska University Hospital, Bruna Stråket 30, SE-413 45 Göteborg, Sweden.
authors.forename: Asa
authors.initials: A
authors.lastname: Lundgren-Nilsson
authors.forename: Gunnar
authors.initials: G
authors.lastname: Grimby
authors.forename: Haim
authors.initials: H
authors.lastname: Ring
authors.forename: Luigi
authors.initials: L
authors.lastname: Tesio
authors.forename: Gemma
authors.initials: G
authors.lastname: Lawton
authors.forename: Anita
authors.initials: A
authors.lastname: Slade
authors.forename: Massimo
authors.initials: M
authors.lastname: Penta
authors.forename: Maria
authors.initials: M
authors.lastname: Tripolski
authors.forename: Fin
authors.initials: F
authors.lastname: Biering-Sørensen
authors.forename: Jane
authors.initials: J
authors.lastname: Carter
authors.forename: Crt
authors.initials: C
authors.lastname: Marincek
authors.forename: Suzanne
authors.initials: S
authors.lastname: Phillips
authors.forename: Anna
authors.initials: A
authors.lastname: Simone
authors.forename: Alan
authors.initials: A
authors.lastname: Tennant
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003071:Cognition; D003431:Cross-Cultural Comparison; D003466:Cultural Characteristics; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000523:psychology; D000071939:Stroke Rehabilitation