A Comparative Study of Item Difficulty Hierarchy of Self-Reported Activity Measure Versus Metabolic Equivalent of Tasks

The purposes of this study were: 1) to show the item difficulty hierarchy of walking/moving construct of the International Classification of Functioning, Disability and Health-Activity Measure (ICF-AM), 2) to evaluate the item-level psychometrics for model fit, 3) to describe the relevant physical activity defined by level of activity intensity expressed as Metabolic Equivalent of Tasks (MET), and 4) to explore what extent the empirical activity hierarchy of the ICF-AM is linked to the conceptual model based on the level of energy expenditure described as MET. One hundred and eight participants with lower extremity impairments were examined for the present study. A newly created activity measure, the ICF-AM using an item response theory (IRT) model and computer adaptive testing (CAT) method, has a construct on walking/moving construct. Based on the ICF category of walking and moving, the instrument comprised items corresponding to: walking short distances, walking long distances, walking on different surfaces, walking around objects, climbing, and running. The item difficulty hierarchy was created using Winstep software for 20 items. The Rasch analyses (1-parameter IRT model) were performed on participants with lower extremity injuries who completed the paper and pencil version of walking/moving construct of the ICF-AM. The classification of physical activity can also be performed by the use of METs that is often preferred to determine the level of physical activity. The empirical item hierarchy of walking, climbing, running activities of the ICF-AM instrument was similar to the conceptual activity hierarchy based on the METs. The empirically derived item difficulty hierarchy of the ICF-AM may be useful in developing MET-based activity measure questionnaires. In addition to convenience of applying items to questionnaires, implications of the finding could lead to the use of CAT method without sacrificing the objectivity of physiologic measures.