title: Poor-fit indexes of Kupperman index: a psychometric analysis based on item response theory.
abstract: OBJECTIVE
  This study aims to test the construct validity of the 11 items of the Kupperman index (KI), which has been pioneering in its attempt to quantify climacteric symptoms.
  
  
  METHODS
  Unidimensional confirmatory factor analysis of the 11 graded items (hot flashes, paresthesia, insomnia, nervousness, melancholia, vertigo, weakness, arthralgia or myalgia, headache, palpitations, and formication), using a four-point scale (0, none; 4, severe), was used to evaluate the KI in a sample consisting of 84 women with a mean (SD) age of 54.34 (4.00) years who have been in menopause for a mean (SD) of 4.36 (2.53) years.
  
  
  RESULTS
  The KI returned poor results on unidimensional model testing (root-mean-square error adjustment, 0.109; 90% CI, 0.075-0.142; comparative fit index, 0.871; Tucker Lewis index, 0.838; weighted root-mean-square residual, 0.971; χ(2)(44) = 87.599; P < 0.001), indicating that the set of items does not properly evaluate the underlying phenomena (climacteric symptoms).
  
  
  CONCLUSIONS
  Our study verifies the poor fit of the KI and provides psychometric evidence that KI items warrant revision and/or that the concept underlying climacteric symptoms should be revisited.
authors.affiliation: From the 1Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil; and 2Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Hugo
authors.initials: H
authors.lastname: Cogo-Moreira
authors.forename: Andrea P
authors.initials: AP
authors.lastname: Jackowski
authors.forename: Teresa R E
authors.initials: TR
authors.lastname: de Araújo
authors.forename: Lucia H L
authors.initials: LH
authors.lastname: Vieira
authors.forename: Mauro A
authors.initials: MA
authors.lastname: Haidar
authors.forename: Ivaldo
authors.initials: I
authors.lastname: Silva
mesh_terms: D002979:Climacteric / Q000502:physiology*; D005163:Factor Analysis, Statistical; D005260:Female; D019584:Hot Flashes / Q000175:diagnosis; D006801:Humans; D008593:Menopause / Q000502:physiology*; D011594:Psychometrics / Q000592:standards*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires