Dimensionality and scaling properties of the Patient Categorisation Tool in patients with complex rehabilitation needs following acquired brain injury

Abstract

OBJECTIVE: To investigate the scaling properties of the Patient Categorisation Tool (PCAT) as an instrument to measure complexity of rehabilitation needs. DESIGN: Psychometric analysis in a multicentre cohort from the UK national clinical database. PATIENTS: A total of 8,222 patents admitted for specialist inpatient rehabilitation following acquired brain injury. METHODS: Dimensionality was explored using principal components analysis with Varimax rotation, followed by Rasch analysis on a random sample of n = 500. RESULTS: Principal components analysis identified 3 components explaining 50% of variance. The partial credit Rasch model was applied for the 17-item PCAT scale using a "super-items" methodology based on the principal components analysis results. Two out of 5 initially created super-items displayed signs of local dependency, which significantly affected the estimates. They were combined into a single super-item resulting in satisfactory model fit and unidimensionality. Differential item functioning (DIF) of 2 super-items was addressed by splitting between age groups (<65 and ≥ 65 years) to produce the best model fit (χ2/df = 54.72, p = 0.235) and reliability (Person Separation Index (PSI) = 0.79). Ordinal-to-interval conversion tables were produced. CONCLUSION: The PCAT has satisfied expectations of the unidimensional Rasch model in the current sample after minor modifications, and demonstrated acceptable reliability for individual assessment of rehabilitation complexity.