title: Development of a cross-cultural item bank for measuring quality of life related to mental health in multiple sclerosis patients.
abstract: OBJECTIVE
  Quality of life (QoL) measurements are considered important outcome measures both for research on multiple sclerosis (MS) and in clinical practice. Computerized adaptive testing (CAT) can improve the precision of measurements made using QoL instruments while reducing the burden of testing on patients. Moreover, a cross-cultural approach is also necessary to guarantee the wide applicability of CAT. The aim of this preliminary study was to develop a calibrated item bank that is available in multiple languages and measures QoL related to mental health by combining one generic (SF-36) and one disease-specific questionnaire (MusiQoL).
  
  
  METHODS
  Patients with MS were enrolled in this international, multicenter, cross-sectional study. The psychometric properties of the item bank were based on classical test and item response theories and approaches, including the evaluation of unidimensionality, item response theory model fitting, and analyses of differential item functioning (DIF). Convergent and discriminant validities of the item bank were examined according to socio-demographic, clinical, and QoL features.
  
  
  RESULTS
  A total of 1992 patients with MS and from 15 countries were enrolled in this study to calibrate the 22-item bank developed in this study. The strict monotonicity of the Cronbach's alpha curve, the high eigenvalue ratio estimator (5.50), and the adequate CFA model fit (RMSEA = 0.07 and CFI = 0.95) indicated that a strong assumption of unidimensionality was warranted. The infit mean square statistic ranged from 0.76 to 1.27, indicating a satisfactory item fit. DIF analyses revealed no item biases across geographical areas, confirming the cross-cultural equivalence of the item bank. External validity testing revealed that the item bank scores correlated significantly with QoL scores but also showed discriminant validity for socio-demographic and clinical characteristics.
  
  
  CONCLUSIONS
  This work demonstrated satisfactory psychometric characteristics for a QoL item bank for MS in multiple languages. This work may offer a common measure for the assessment of QoL in different cultural contexts and for international studies conducted on MS.
authors.affiliation: Aix-Marseille University, EA3279: Public Health, Chronic Diseases and Quality of Life, Research Unit, 13005, Marseille, France, pierre.michel@univ-amu.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Michel
authors.forename: Pascal
authors.initials: P
authors.lastname: Auquier
authors.forename: Karine
authors.initials: K
authors.lastname: Baumstarck
authors.forename: Jean
authors.initials: J
authors.lastname: Pelletier
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
authors.forename: Badih
authors.initials: B
authors.lastname: Ghattas
authors.forename: Laurent
authors.initials: L
authors.lastname: Boyer
mesh_terms: D000328:Adult; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology*; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires