title: Should symptoms be scaled for intensity, frequency, or both?
abstract: OBJECTIVE
  This study evaluated the comparability of two 5-point symptom self-report rating scales: Intensity (from "not at all" to "very much") and Frequency (from "none of the time" to "all of the time"). Questions from the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue 13-item scale was examined.
  
  
  METHODS
  Data from 161 patients (60 cancer, 51 stroke, 50 HIV) were calibrated separately to fit an item response theory-based rating scale model (RSM). The RSM specifies intersection parameters (step thresholds) between two adjacent response categories and the item location parameter that reflects the probability that a problem will be endorsed. Along with patient fatigue scores ("measures"), the spread of the step thresholds and between-threshold ranges were examined. The item locations were also examined for differential item functioning.
  
  
  RESULTS
  There was no mean raw score difference between intensity and frequency rating scales (37.2 vs. 36.4, p = n.s.). The high correlation (r = .86, p < .001) between the intensity versus frequency scores indicated their essential equivalence. However, frequency step thresholds covered more of the fatigue measurement continuum and were more equidistant, and therefore reduced floor and ceiling effects.
  
  
  CONCLUSIONS
  These two scaling methods produce essentially equivalent fatigue estimates; it is difficult to justify assessing both. The frequency response scaling may be preferable in that it provides fuller coverage of the fatigue continuum, including slightly better differentiation of people with relatively little fatigue, and a small group of the most fatigued patients. Intensity response scaling offers slightly more precision among the patients with significant fatigue.
authors.affiliation: Center on Outcomes, Research and Education (CORE), Evanston Northwestern Healthcare, Evanston, Illinois, USA. chchang@northwestern.edu
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Chang
authors.forename: David
authors.initials: D
authors.lastname: Cella
authors.forename: Susan
authors.initials: S
authors.lastname: Clarke
authors.forename: Allen W
authors.initials: AW
authors.lastname: Heinemann
authors.forename: Jamie H
authors.initials: JH
authors.lastname: Von Roenn
authors.forename: Richard
authors.initials: R
authors.lastname: Harvey
mesh_terms: D002908:Chronic Disease / Q000523:psychology*; D005221:Fatigue / Q000175:diagnosis*; D005260:Female; D015658:HIV Infections / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology; D011594:Psychometrics / Q000379:methods*; D011788:Quality of Life; D018709:Statistics, Nonparametric; D020521:Stroke / Q000523:psychology; D011795:Surveys and Questionnaires