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. 2023 Nov 18;16(11):1867-1875.
doi: 10.18240/ijo.2023.11.20. eCollection 2023.

Development of a new 17-item Asthenopia Survey Questionnaire using Rasch analysis

Na Lin  1 , Xiao-Man Li  1 , Mao-Yuan Yang  2 , Li Tian  2 , Zhi-Hua Li  2 , Jie-Li Mao  2 , Jia-Fang Zhang  2 , Jie Chen  1 , Fan Lyu  1 , Ru-Zhi Deng  1
Affiliations

Development of a new 17-item Asthenopia Survey Questionnaire using Rasch analysis

Na Lin et al. Int J Ophthalmol. .

Abstract

Aim: To develop the 17-item Asthenopia Survey Questionnaire (ASQ)-17 by Rasch analysis, and to generate a predictiveness score.

Methods: Totally 739 participants were recruited and 680 were involved in the result analysis in this prospective, cross-sectional study. Three rounds of Rasch analysis were used to analyze the psychometric characteristics of items and options.

Results: Phase 1 assessed the original ASQ-19, adjusted the item scoring mode to a four-point Likert response rating scale and combined the 18th and 19th items into a new item. Phase 2 deleted the 11th item. Phases 3 and 4 assessed the new ASQ-17. All the evaluation indexes of ASQ-17 were acceptable. The Infit and Outfit MnSq values of items were 0.67-1.48, the variance explained by the principal component and the unexplained variance explained by the first contrast were 53.90%-59.40% and 1.50-1.80 in three dimensions. The curve peaks of scores in each dimension were separated and in the same order. The PSR and PSI values were 2.80 and 0.89, respectively. The mean scores of dimensions A (9.5±4.1 vs 3.5±3.2), B (7.3±3.3 vs 2.5±2.7), C (4.3±2.2 vs 1.4±2.0) and total (21.1±8.1 vs 7.4±7.0) in asthenopia participants were significantly higher than those without asthenopia (all P<0.001). The area under the curve in two groups was 0.899 (P<0.001). Youden's index was up to the maximum value of 0.784 when the cut-off value was 12.5.

Conclusion: ASQ-17 has stronger option sorting and suitability than ASQ-19. It is an effective assessment tool for asthenopia with an optimal cut-off threshold value of 12.5, which is suitable for diagnosis and curative effect evaluation.

Keywords: 17-item Asthenopia Survey Questionnaire; Rasch analysis; asthenopia; scoring mode.

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Figures

Figure 1
Figure 1. Category probability curves for the difficulty questions with 4 categories before (ASQ-19) and after (ASQ-18 and ASQ-17) combining 1, 2, 3 scores and 4, 6 scores
ASQ: Asthenopia Survey Questionnaire; The y-axis is the response category probability, and the x-axis is a measure relative to item difficulty. ASQ-19: The curve peaks of 1, 2, 3 scores and 4, 6 scores contained with each other, and 0, 9 scores were independent, therefore 1, 2, 3 scores and 4, 6 scores can be combined into one category. ASQ-18 and ASQ-17: The curve peaks of 0, 1, 2, and 3 scores were separated from each other and in the same order, indicating that the four options (response categories are: 0: none, 1: mild, 2: moderate, 3: severe) were reasonable.
Figure 2
Figure 2. Comparison of mean total scores for asthenopia and non-asthenopia participants used ASQ-17
ASQ-17: The 17-item Asthenopia Survey Questionnaire. The columns in black are the mean scores of asthenopia participants (n=198) and the columns in grey are the mean scores of non-asthenopia participants (n=97). aP<0.001.
Figure 3
Figure 3. The ROC of ASQ-17 in asthenopia and non-asthenopia participants
ROC: Receiver operating characteristic curve; ASQ-17: The 17-item Asthenopia Survey Questionnaire. The area under the curve was 0.899 (P<0.001), indicating ASQ-17 has good diagnosability. Youden's index was up to the maximum value of 0.784 when the cut-off value was 12.5, and the specificity and sensitivity index were 78.4%, and 100.0% respectively (the red dot).
Figure 4
Figure 4. The mean score of 17 items in ASQ-17 in descending order
ASQ-17: The 17-item Asthenopia Survey Questionnaire. The maximum mean score for an item is 8th, closely followed by items 1st, 2nd, and 4th.
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