iSAT於年輕成人之心理計量特性驗證 (1013 renew)

Validation of psychometric properties of an iPad-based Selective Attention Test in young adults 

N=54 (M=28, F=26) mean age=24.4 years; mean education years=16.1 years

1. Test-retest reliability, random measurement error and practice effect: 
(1) Moderate test-retest reliability for all 4 indices
(2) Acceptable random measurement error for the L and LD indices
     Substantial random measurement error for the H and HD indices
(3) Small to moderate practice effect for the L and LD indices
      Moderate to high practice effect for the H and HD indices

Indices	ICC (95% CI)	SEM (SEM%)	MDC (MDC%)	Effect size (s: significant; ns: not significant)
Low load (L)	0.65 (0.44-0.78)	0.04 (6.6%)	0.12 (18.4%)	0.25 (s)
Low load with Distractor (LD)	0.53 (0.30-0.70)	0.05 (8.2%)	0.15 (22.6%)	0.32 (s)
High load (H)	0.58 (0.02-0.81)	0.20 (12.0%)	0.56 (33.2%)	0.70 (s)
High load with Distractor (HD)	0.59 (0.24-0.78)	0.23 (13.2%)	0.62 (36.6%)	0.55 (s)

2. Convergent validity: 
Correlation with T-SDMT: acceptable

L	H	HD
r=0.30	r=0.40	r=0.46

3. Discriminative validity: Yes

For all 4 indices, the scores of participants with scores higher than the highest 25% of data were significantly different than those of participants with scores lower than the lowest 25% of data (p<0.001). 

4. Construct validity: not fitting with perceptual load theory
The results of the iSAT in young adults did not confirm the hypothesis of perceptual load theory.

iSAT於思覺失調症患者之驗證結果 (1020 renew)

Validation of an iPad-based Selective Attention Test in patients with schizophrenia

N=51 (M=25, F=26) mean age=47.2yrs; mean education years=11.2yrs; mean age of onset=24.8yrs; range of CGIS=1-4

1. Test-retest reliability, random measurement error and practice effect: 
Low load indices: good
High load indices: need to be improved due to substantial random measurement error and moderate practice effect

Indices	ICC   (95% CI)	SEM (SEM%)	MDC (MDC%)	Effect size (s: significant; ns: not significant)
Low load (L)	0.89  (0.80-0.94)	0.11  (9.5%)	0.29  (26.3%)	0.14 (s)
Low load with Distractor (LD)	0.88   (0.78-0.93)	0.12  (10.8%)	0.35  (29.8%)	0.15 (s)
High load (H)	0.75   (0.33-0.89)	0.40  (14.6%)	1.11  (40.5%)	0.43 (s)
High load with Distractor (HD)	0.74   (0.41-0.87)	0.47  (16.8%)	1.31  (46.4%)	0.39 (s)

(1) The ICC for the L and LD indices ranged from 0.88 to 0.89, indicating that both low load indices had high test-retest reliability.

(2) The ICC for the H and HD indices ranged from 0.74 to 0.75, indicating that both high load indices had acceptable test-retest reliability.

(3) Our results showed that both low load indices had acceptable random measurement error, whereas both high load indices had substantial random measurement error.
*The criterion for the MDC% was set at 30%. MDC%<30% indicates acceptable random measurement error.

(4) A significant practice effect was shown between repeated assessments for all four indices. For both low load indices, the practice effect was negligible; whereas for both high load indices, the practice effect was around moderate.

2. Convergent validity 
(1) Correlation with MoCA: acceptable

L	LD	H	HD
0.42	0.43	0.48	0.47

All four indices had fair correlations with the MoCA, indicating acceptable convergent validity. (2) Correlation with CGIS: insufficient Only the L and LD indices had weak correlations (r=0.28-0.29) with the CGIS, indicating insufficient convergent validity. 3. Discriminative validity: Yes (1) MoCA≧26 [good global cognition, N=14] vs. <26 [poor global cognition, N=37]: All 4 indices had discriminative validity to discriminate participants with/without poor global cognitive function. (2) Young adult (n=16) vs. middle-aged adult and elderly (n=35): All four indices had discriminative validity to discriminate young adult and middle-aged/elderly adult participants. 4. Ecological validity: partial, correlation with the Personal and Social Performance (PSP) Only the H and HD indices had significant weak correlation (r=0.29-0.31) with the PSP, indicating limited ecological validity. 5. Construct validity: fitting with perceptual load theory The results of the iSAT in patients with schizophrenia confirmed the hypothesis of perceptual load theory.  Participants' response time became slower (>0.04 seconds) when the distractor showed up in the low load condition. However, the distractor did not affect the participants' response time in the high load condition. *How to reduce moderate practice effect in the high load condition: To set up a criterion for response time to reach a plateau phase of selective attention performance.

慢性思覺失調症收案將近尾聲

本週五將收完最後一位慢性思覺失調症患者的再測
2個月的慢性個案收案（接近50位個案）也將告一段落了
接下來就是資料的彙整和跑分析了

這二個月所接觸的精神科個案
應該可以抵三次精神科實習的個案量吧
因為畢業以後接觸的多為小兒和生理的個案
所以一開始評估思覺失調症患者時
真的覺得自己很菜
完全沒有進入狀況的感覺
後來我改變心態
先肯定自己是可以在不熟悉的環境裡完成收案
再來是跟病患/護理師說明自己是ＯＴ老師（不是研究助理）
（因為想讓個案/護理師知道自己也是精神醫療相關專業人員）
同時也盡量配合護理站的時間（11點和16點前完成評估）
和空間使用（只要有桌椅，二道門間的走廊也可以評估）
另外也盡可能在40分鐘內完成一位個案的評估
後來的收案真的變得很專業
當然評估本身就是ＯＴ的專業
只是因為我是外人
我必須要讓評估這件事情更有一定的程序
醫院的人員也才會重視這件事情
不然病人沒有完成評估對醫院來說並沒有任何影響

這次的收案對我來說
就像進入一個新工作
慢慢熟悉新環境的人事物
（需花時間建立關係）
同時也是一個很好的機會
讓我可以一邊做臨床一邊做研究
對一個測驗發展者而言
這真是一個很棒的經歷
能夠親眼看到病人做測驗的所有反應
而且可以得到他們直接的回饋
真的是很難得

iSAT於思覺失調症患者之心理計量驗證收案規畫

桃療：5月8日那週開始，那週會找一天過去確認收案流程。
靜和：8月份開始收案，預計9月底前完成。

iSAT/T-SDMT於年輕成人之再測信度/收斂效度驗證人數小記

第一波收案將於5月初結束

預計收滿26人

10男16女

下一波受試者招募將於下週展開

將再於PTT post招募文宣

T-SDMT不同施測次數之反應性與預測效度比較 0406 renew

一、團體層級反應性

	單一評估	二次平均	三次平均
Post-Pre difference Mean (SD)	3.2 (6.6)	3.2 (5.7)	3.3 (5.6)
ES (95% CI)	0.25       (0.11-0.43)	0.25 (0.14-0.41)	0.25 (0.13-0.40)
SRM  (95% CI)	0.49  (0.24-0.75)	0.57 (0.39-0.85)	0.58 (0.36-0.89)

*團體層級反應性：三種評估方式無顯著差異。

二、個體層級反應性

	單一評估	二次平均	三次平均
顯著進步	20%	16%	16%
進步但不顯著	44%	54%	58%
無進步或退步	30%	28%	22%
顯著退步	6%	2%	4%

*個體層級反應性：三種評估方式無顯著差異(p>0.24)。
進一步分成 進步 vs. 無進步或退步 二群：三種評估方式無顯著差異(p>0.05)。

三、預測效度

	單一評估 Pearson’s r  (95% CI)	二次平均 Pearson’s r (95% CI)	三次平均 Pearson’s r (95% CI)
BI	0.47 (0.22-0.66)	0.45 (0.19-0.65)	0.44 (0.19-0.64)
BI-SS自覺困難	0.46 (0.21-0.66)	0.45 (0.19-0.64)	0.45 (0.19-0.65)
BI-SS執行能力	0.43 (0.17-0.63)	0.40 (0.13-0.61)	0.39 (0.12-0.60)

*預測效度：三種評估方式無顯著差異。

**隨著評估次數增加，相關係數些微遞減。

當reviewer的感覺

近日審查的一篇注意力測驗再測信度驗證論文

依據我的建議改到了R2

看著作者一路修正下來

其實是會被感動的

原來當reviewer是這種感覺~

以前我最怕的就是回response letter

常常不知怎麼應付reviewer

但現在我比較知道怎麼回覆

其實只要站在reviewer的立場去想

思考為什麼reviewer會給這樣的意見

然後在不失自己立場的情況下

給予適切的回覆

一般而言都會有正面的回饋~

我今天看了對方的R2回覆

發現對方全都接受自己的建議

其實還蠻開心的

內心覺得可以給他過了

雖然會再看一次他修改過的全文

但是基本上也已經改得差不多了~

reviewer真的是為他人作嫁衣

花了很多自己的時間

幫別人修改論文

而論文真的會越改越好的

真的是在做功德~

T-SDMT應用於中風病患之反應性/預測效度驗證結果 3/29 renew

一、結果：
1. 人口學資料
(1)共納入58位中風住院病患，有8位未完成後測，故共有50位病患納入分析。入出院評估間隔時間中位數為14天。
(2) 50位病患中，有33位男性/17位女性，平均年齡為58.4歲。

2. 團體層級反應性：
(1) 二次評估分數具備顯著差異，p<0.001
(2) SRM=0.58; ES=0.25
(3) 若以接受OT治療時間2週為間隔分二組
治療時間2週內(7~13天) vs. 治療時間2週以上(14~20天)

	SRM	ES
Interval <2 weeks	0.59 (0.21-1.07)	0.16 (0.05-0.29)
Interval >=2 weeks	0.60 (0.36-1.17)	0.38 (0.16-0.73)

*團體層級反應性無顯著差異。

3. 個體層級反應性：病患T-SDMT變化分數與MDC (6.7個答對項目數) 比較

	OT治療2週內 (n=23)	OT治療2週以上 (n=27)	Overall (n=50)
顯著進步	13.0%	18.5%	16.0%
進步但不顯著	60.9%	55.6%	58.0%
無進步或退步	21.7%	22.2%	22.0%
顯著退步	4.3%	3.7%	4.0%

(1) 二組分布沒有顯著差異 (p=0.959)
(2) 二組MDC ratio也沒有顯著差異 (p=0.307)

4.預測效度：
入院T-SDMT分數與出院BI分數呈現顯著中度相關(Pearson's r=0.44)，與BI-SS自覺困難次量表分數呈現顯著中度相關(Pearson's r=0.45)，與BI-SS執行能力次量表分數呈現顯著低度相關(Pearson's r=0.38)。

二、結論：
T-SDMT應用於中風病患具備適當之反應性及預測效度。

Model fit reports for possible FAI models 20170313 renew

Model fit reports for ten FAI models

Because the floor effect of our sample (n=420) was marked (23.1%, >20%), we used robust maximum likelihood to correct the estimation bias due to the nonnormal distribution of data.

Criteria for selecting items for each factor in the models that authors did not describe clearly: factor loadings > 0.40 would be included.

*Model 1 Some stroke studies, or most frequently clinical use of FAI
IADL=the sum of item 1~15

Fit statistic	Model fit	Criteria
x2/df	6.58	<3
CFI TLI	0.74 0.70	at least 0.90 at least 0.90
RMSEA SRMR	0.12 0.09	<0.08 <0.08
Conclusion	poor fit

* Model 2 Holbrook & Skilbeck (1983)

Factor 1: Domestic chores: item 1-5

Factor 2: Leisure/work: item 7, 9, 10, 11, 13, 14, 15

Factor 3: Outdoors: item 6, 8, 10, 11, 12

Fit statistic	Model fit	Criteria
x2/df	2.71	<3
CFI TLI	0.93 0.91	at least 0.90 at least 0.90
RMSEA SRMR	0.06 0.05	<0.08 <0.08
Conclusion	acceptable fit

Model 3 Wade et al. (1985) (Delete: No specific naming for one or more factors) 

Factor 1: item 8, 10, 12, 13, 15
Factor 2: item 1-6 (questionable negative high [>0.5]  factor loadings)

Factor 3: item 7, 9, 11, 14 (questionable negative high  [>0.5] factor loadings)

Fit statistic	Model fit	Criteria
x2/df	4.11	<3
CFI TLI	0.86 0.83	at least 0.90 at least 0.90
RMSEA SRMR	0.09 0.07	<0.08 <0.08
Conclusion	poor fit

Model 4 Cockburn et al. (1990) (Delete: no specific naming for one or more factors)

Factor 1 (?): item 1-14

Factor 2 physically demanding activities: item 10, 12, 13

Factor 3 social awareness: item 7, 14 
item 15 (few responses) was not included

Fit statistic	Model fit	Criteria
x2/df	6.73	<3
CFI TLI	0.79 0.72	at least 0.90 at least 0.90
RMSEA SRMR	0.12 0.09	<0.08 <0.08
Conclusion	poor fit

Model 5 Bond et al. (1992)

Factor 1: Indoor domestic chores: item 1, 2, 3, 4, 5

Factor 2: Outdoor social activities: item 6, 7, 8, 11

Factor 3: Outdoor domestic chores: item 10, 12, 13
item 9, 14, 15 were not included due to low factor loadings (<0.4)

Fit statistic	Model fit	Criteria
x2/df	3.49	<3
CFI TLI	0.93 0.90	at least 0.90 at least 0.90
RMSEA SRMR	0.08 0.05	<0.08 <0.08
Conclusion	poor fit

* Model 6 Schuling et al. (1993)

Factor 1: Domestic chores: item 1-5

Factor 2: Outdoors activities: item 6-13

item 14, 15 were not included

Fit statistic	Model fit	Criteria
x2/df	3.64	<3
CFI TLI	0.91 0.89	at least 0.90 at least 0.90
RMSEA SRMR	0.08 0.06	<0.08 <0.08
Conclusion	poor fit

* Model 7 Sveen et al. (1999)

Factor 1: Domestic chore: item 1-5

Factor 2: Outdoor (work/leisure): item 6, 7, 8, 10, 11, 13

Factor 3: Hobby: item 9, 14
item 12, 15 were not included

Fit statistic	Model fit	Criteria
x2/df	3.19	<3
CFI TLI	0.92 0.91	at least 0.90 at least 0.90
RMSEA SRMR	0.07 0.06	<0.08 <0.08
Conclusion	poor fit

* Model 8 Han et al. (2006) ; Lin (2012)

Factor 1: Domestic chores: item 1-6

Factor 2: Work/leisure: item 7-15

Fit statistic	Model fit	Criteria
x2/df	4.13	<3
CFI TLI	0.86 0.83	at least 0.90 at least 0.90
RMSEA SRMR	0.09 0.08	<0.08 <0.08
Conclusion	poor fit

Model 9 Hsieh et al. (2007)
IADL=item 1+item 2+item 3+item 4+item 5+item 6+item7+item 9+item 10+item 11+item 12+item 13+item 15
Item 8, 14 were not included due to misfit to the Rasch model

Fit statistic	Model fit	Criteria
x2/df	7.34	<3
CFI TLI	0.76 0.71	at least 0.90 at least 0.90
RMSEA SRMR	0.12 0.10	<0.08 <0.08
Conclusion	poor fit

Model 10 Han et al. (2009)

Factor 1: Domestic chores: item 1, 2, 3, 4, 6

Factor 2: Outdoor work: item 11, 12, 13, 15

Factor 3: Leisure: item 5, 8, 10

Factor 4: Hobby: item 7, 9, 14

Fit statistic	Model fit	Criteria
x2/df	5.10	<3
CFI TLI	0.82 0.78	at least 0.90 at least 0.90
RMSEA SRMR	0.10 0.08	<0.08 <0.08
Conclusion	poor fit

* Model used in patients with stroke

Conclusion: 
Model 2 had acceptable fit.