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Reliability and Validity of the School Function Assessment for Children with Disabilities in Korea: Applying Rasch Analysis

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Title: Reliability and Validity of the School Function Assessment for Children with Disabilities in Korea: Applying Rasch Analysis
Language: English
Authors: Kim, Hun Ju (ORCID 0000-0002-0900-5663), Lee, Sung Ja (ORCID 0000-0001-9411-1091), Kam, Kyung-Yoon (ORCID 0000-0002-0387-1843)
Source: International Journal of Disability, Development and Education. 2023 70(1):32-44.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 13
Publication Date: 2023
Document Type: Journal Articles
Reports - Research
Education Level: Elementary Education
Descriptors: Foreign Countries, Test Validity, Test Reliability, Occupational Therapy, Students with Disabilities, Intellectual Disability, Elementary School Students, Test Items, Difficulty Level, Rating Scales, Symptoms (Individual Disorders), Physical Disabilities, Ability
Geographic Terms: South Korea
DOI: 10.1080/1034912X.2020.1870665
ISSN: 1034-912X
1465-346X
Abstract: This study verified validity and reliability of the School Function Assessment (SFA) using Rasch analysis in South Korean school-based occupational therapy sites serving children with intellectual disabilities and others. Participants were 103 elementary school children (grades 1 through 6) with disabilities. Rasch analysis revealed several misfitting items. Difficulty levels of items, presented in hierarchical order, were very different from those found at the time of development of the SFA. Results for the rating scale fit showed that a 4-point scale, rather than the existing 6-point scale, was more appropriate for several parts of the SFA in the Korean context. Separation reliability ranged from good to very good, with coefficients from 0.85 to 0.99. This study contributes to the literature by verifying the reliability and validity of the SFA for students who need school-based occupational therapy in Korea using Rasch analysis, with a focus on applying it to children with intellectual disabilities and autistic spectrum disorders. For more efficient application of the SFA in South Korea in the future, it remains necessary to modify the misfitting items, rearrange their difficulty levels, and properly adjust the rating scales rather than evaluating items by literally translating them into Korean.
Abstractor: As Provided
Entry Date: 2023
Accession Number: EJ1376870
Database: ERIC
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  Value: <anid>AN0161419910;54q01jan.23;2023Jan24.04:37;v2.2.500</anid> <title id="AN0161419910-1">Reliability and Validity of the School Function Assessment for Children with Disabilities in Korea: Applying Rasch Analysis </title> <p>This study verified validity and reliability of the School Function Assessment (SFA) using Rasch analysis in South Korean school-based occupational therapy sites serving children with intellectual disabilities and others. Participants were 103 elementary school children (grades 1 through 6) with disabilities. Rasch analysis revealed several misfitting items. Difficulty levels of items, presented in hierarchical order, were very different from those found at the time of development of the SFA. Results for the rating scale fit showed that a 4-point scale, rather than the existing 6-point scale, was more appropriate for several parts of the SFA in the Korean context. Separation reliability ranged from good to very good, with coefficients from.85 to.99. This study contributes to the literature by verifying the reliability and validity of the SFA for students who need school-based occupational therapy in Korea using Rasch analysis, with a focus on applying it to children with intellectual disabilities and autistic spectrum disorders. For more efficient application of the SFA in South Korea in the future, it remains necessary to modify the misfitting items, rearrange their difficulty levels, and properly adjust the rating scales rather than evaluating items by literally translating them into Korean.</p> <p>Keywords: Autistic Spectrum Disorders; children with disabilities; intellectual disabilities; Korea; Rasch analysis; reliability; school function assessment; school-based occupational therapy; validity</p> <hd id="AN0161419910-2">Introduction</hd> <p>School-based occupational therapists (OTs) help children with disabilities successfully participate in regular curricula, which consist of academic and non-academic activities (Case-Smith & O'Brien, [<reflink idref="bib2" id="ref1">2</reflink>]). OTs provide appropriate support in accordance with the various characteristics and educational desires of the target children. They help children cooperate with their peers in integrated spaces by directly observing and intervening in the activities performed in the classroom, playground, cafeteria, and so on (Lee, Jung, & Lee, [<reflink idref="bib13" id="ref2">13</reflink>]).</p> <p>In schools, occupational therapists assess students and provide information about their specific, abstract, isolated skills, rather than their functional ability to interact within the physical and social environment of real-life school settings (Li, Dong, & Fong, [<reflink idref="bib16" id="ref3">16</reflink>]). To improve the class participation and activity performance of children with disabilities, a functional assessment that examines the children's actual performance in the school environment – rather than scores generated from assessment tools using standardised general performance components – is needed (Hwang, Nochajski, Linn, & Wu, [<reflink idref="bib9" id="ref4">9</reflink>]). In order to perform functional tasks at school, children require a variety of physical, cognitive, and behavioural skills. Therefore, the School Function Assessment (SFA) was developed to comprehensively evaluate children in school environments by addressing the limitations of prior assessment tools (Coster, [<reflink idref="bib5" id="ref5">5</reflink>]; Haley, Coster, & Faas, [<reflink idref="bib7" id="ref6">7</reflink>]).</p> <p>The SFA is an assessment tool that sequentially arranges question items by considering the difficulty levels of the items in each section based on the Rasch analysis results. For this reason, changes in the test items performed by children with disabilities can be recoded as changes in their skill level, reflected in their treatment plan, and used to measure treatment effectiveness (Park, [<reflink idref="bib21" id="ref7">21</reflink>]).</p> <p>The assessments that school-based occupational therapists currently use in Korea focus on the overall development and functions of the students, including daily life activities, movements in school, using transportation, and gross and fine motor skills. Among the many assessments currently used, the SFA only evaluates functional task performance abilities in actual school settings (Lee, Kim, & Kam, [<reflink idref="bib15" id="ref8">15</reflink>]). In a survey of 35 assessment tools used for school-based occupational therapy in Korea, SFA was the fifth highest, but it did not have a high frequency of use (1.8 out of 5) (Lee et al., [<reflink idref="bib15" id="ref9">15</reflink>]). A study of the use of paediatric occupational therapy assessment tools in Korea found that only 2.9% of paediatric occupational therapists used the SFA (Lee, Hong, & Park, [<reflink idref="bib14" id="ref10">14</reflink>]).</p> <p>The contents of SFA cover all major areas of functioning related to school settings, both inside and outside the classroom. Specific attention is given to areas of functioning that may be particularly demanding for students with physical and/or sensory impairments (Strein & Kuhn-McKearin, [<reflink idref="bib25" id="ref11">25</reflink>]). The SFA also evaluates the non-academic functioning of students with significant motor impairments, such as cerebral palsy (Sakzewski, Boyd, & Ziviani, [<reflink idref="bib23" id="ref12">23</reflink>]). Globally, most researchers and practitioners who study autism spectrum disorders are unfamiliar with the SFA (Strein & Kuhn-McKearin, [<reflink idref="bib25" id="ref13">25</reflink>]). However, the majority of Korean students who need school-based occupational therapy are children with intellectual and autism spectrum disorders, rather than physical or sensory impairments. Special attention is needed to validate the SFA for students who need school-based occupational therapy in Korea.</p> <p>Recently, Rasch analysis, based on item response theory, has been actively applied to evaluate the validity of assessment tools (Cordier et al., [<reflink idref="bib4" id="ref14">4</reflink>]; Higashi et al., [<reflink idref="bib8" id="ref15">8</reflink>]). Rasch analysis can be used to analyse the fitness and difficulty of evaluation items. It can also be used to analyse or apply category fitness, observed change, category frequency, and probability curve to make rating scales more suitable. For this reason, Rasch analysis is useful for verifying instrument validity (Bond & Fox, [<reflink idref="bib1" id="ref16">1</reflink>]).</p> <p>The SFA consists of three parts. Part I covers participation in activity settings; Part II covers task support; and Part III covers activity performance. Parts I and II can be used as screening tools (Strein & Kuhn-McKearin, [<reflink idref="bib25" id="ref17">25</reflink>]).</p> <p>Although the SFA has been well known to have good reliability and validity, it is a context-related assessment tool and thus should be carefully verified in different countries and cultural areas (Li et al., [<reflink idref="bib16" id="ref18">16</reflink>]). Previous research has examined versions of the SFA used in Taiwan and China. Researchers examined translation and cultural adaptation to verify the reliability and validity of SFA for students in those countries (Hwang et al., [<reflink idref="bib9" id="ref19">9</reflink>]; Li et al., [<reflink idref="bib16" id="ref20">16</reflink>]). Studies that have examined SFA in different cultural contexts have focused exclusively on children with cerebral palsy and resulting in severe motor disorders (Hwang & Davies, [<reflink idref="bib10" id="ref21">10</reflink>]; Li et al., [<reflink idref="bib16" id="ref22">16</reflink>]). However, it is difficult to generalise these findings in the Korean context because 53.7% of special education students in Korea have intellectual disabilities, and 13.4% have autism spectrum disorder (Ministry of Education, [<reflink idref="bib19" id="ref23">19</reflink>]). A separate study is needed to develop the SFA for children with intellectual disabilities and autistic spectrum disorders. We propose using Rasch analysis to verify the reliability and validity of the SFA in various national and cultural contexts.</p> <p>This study develops an SFA that can be applied to Korean students who need school-based occupational therapy, the majority of whom have intellectual disabilities. To do this, the present study uses Rasch analysis to verify the fitness of the SFA by analysing the misfitting items, difficulty of the items, fitness of the rating scales, and separation reliability.</p> <hd id="AN0161419910-3">Materials and Methods</hd> <p></p> <hd id="AN0161419910-4">Study Participants</hd> <p>The participants in this study were 103 elementary school children (grades 1 through 6) with disabilities in the city of Ulsan, South Korea. This study analysed the results of SFA assessments performed on students, who had applied for school-based occupational therapy support services. The evaluation was conducted by school-based OTs interviewing the parents of the students between 17 December 2018 and 23 January 2019. The special education support centre in Ulsan, South Korea, approved the use of information for this study. This study did not collect additional information from the participants. Male students accounted for 70.9% of the participants, while females accounted for 29.1%. The highest proportion of participants (32%) were in grade 1. Most of the participants, 70.9%, attended a special classroom, while 29.1% were integrated into a regular classroom. Students who attended both a special and regular classroom were asked to indicate in which classroom they spent more time. Of the participants, 44.7% had intellectual disabilities, 24.3% had autistic spectrum disorders, 12.6% had a developmental delay, 7.8% had cerebral palsy, and 5.8% had physical disabilities. Other diagnoses were emotional, behavioural, speech, and auditory disorders (Table 1).</p> <p>Table 1. General characteristics of subjects (n = 103).</p> <p> <ephtml> <table><thead><tr><td /><td>Characteristics</td><td>Subjects(n)</td><td>Percentage(%)</td></tr></thead><tbody><tr><td>Gender</td><td>Male</td><td>73</td><td>70.9</td></tr><tr><td>Female</td><td>30</td><td>29.1</td></tr><tr><td>Grade</td><td>1</td><td>33</td><td>32.0</td></tr><tr><td>2</td><td>26</td><td>25.2</td></tr><tr><td>3</td><td>19</td><td>18.5</td></tr><tr><td>4</td><td>12</td><td>11.7</td></tr><tr><td>5</td><td>4</td><td>3.9</td></tr><tr><td>6</td><td>9</td><td>8.7</td></tr><tr><td>Classroom type</td><td>Special educational classroom</td><td>73</td><td>70.9</td></tr><tr><td>Regular classroom</td><td>30</td><td>29.1</td></tr><tr><td>Primary means of mobility</td><td>Walks on own</td><td>98</td><td>95.1</td></tr><tr><td>Walking with an assistant</td><td>4</td><td>3.9</td></tr><tr><td>Walker</td><td>1</td><td>1.0</td></tr><tr><td>Diagnostic characteristics</td><td>Intellectual disability</td><td>46</td><td>44.7</td></tr><tr><td>Autism spectrum disorder</td><td>25</td><td>24.3</td></tr><tr><td>Developmental delay</td><td>13</td><td>12.6</td></tr><tr><td>Brain injury</td><td>8</td><td>7.8</td></tr><tr><td>Physical disability</td><td>6</td><td>5.8</td></tr><tr><td>Emotional and behavioural disorders</td><td>2</td><td>1.9</td></tr><tr><td>Speech disorder</td><td>2</td><td>1.9</td></tr><tr><td>Hearing impairment</td><td>1</td><td>1.0</td></tr></tbody></table> </ephtml> </p> <hd id="AN0161419910-5">The School Function Assessment (SFA)</hd> <p>The SFA is an assessment tool developed to evaluate children's performance levels and functional abilities in elementary school settings (Coster, [<reflink idref="bib5" id="ref24">5</reflink>]). The SFA consists of three parts: participation (Part I), task support (Part II), and activity performance (Part III). Part I of the SFA evaluates the degree to which the student participates in the six major school activity settings. Part II evaluates the support provided to the student during their performance of school-related functional task. These tasks include 12 physical task items, including 3 optional task items, and 9 cognitive/behavioural task items. Part III evaluates the student's execution of school-related functional tasks. The physical tasks include 171 items using 12 task scales, and the cognitive/behavioural tasks include 121 items using 9 scales.</p> <p>The internal consistency coefficient (Cronbach's α) of the SFA ranged from.92 to.98. The Pearson correlation coefficient between test and retest ranged from.80 to.99 (Coster, [<reflink idref="bib5" id="ref25">5</reflink>]).</p> <hd id="AN0161419910-6">Analysis Methods</hd> <p>This study used Winsteps 4.4.4 to conduct Rasch analysis of the SFA. It analysed the fitness of the items, difficulty levels of the items, fit of the rating scales, and separation reliability.</p> <p>Infit and outfit indices were used to examine the unidimensional model fitness of the SFA. The infit index is more sensitive to items closely connected to the subject's ability levels, and the outfit index is more sensitive to items far from the subject's ability levels. Based on the statistical hypothesis test principle, a Z (the fit statistic) of 2.0 or higher means that the probability of observation is.05 or lower. This study used Hwang and Davies ([<reflink idref="bib10" id="ref26">10</reflink>]) criteria for misfitting items; an item was judged as misfitting when the MnSq of its infit or outfit was greater than 1.4, and the Z value was higher than 2.0.</p> <p>The difficulty of items is estimated based on the participant's responses and indicates how difficult the participant perceives the items to be. Although an exact range was not established for difficulty levels, on average, −1.0 indicates easy items, 0.0 indicates medium-difficult items, and 1.0 indicates difficult items (Chi & Chae, [<reflink idref="bib3" id="ref27">3</reflink>]).</p> <p>The scale category was judged appropriate when the outfit MnSq was 2.0 or lower, or the observed average monotonically increased, and when the interval between the step calibration values of the adjacent scales ranged from 1.0 to 5.0 logits (Linacre, [<reflink idref="bib17" id="ref28">17</reflink>]). When a scale was considered misfitting, it was integrated with adjacent scales to reconstruct and reanalyse it to meet the fitness criteria of the rating scales.</p> <p>The standard error of separation reliability was calculated based on the participant's ability level, independent of the standard group. The separation reliability is divided into item and person separation reliability. These estimated separation indices represent concepts of standard error; the larger the index is, the more accurate its measurement. The separation reliability ranges from 0 to 1. It is conceptually the same as Cronbach's α: the closer the value is to 1, the more desirable it is. The separation reliability is considered acceptable with a coefficient of.70 or higher and a separation index of 1.50; it is considered good with a coefficient of.80 or higher and an index of 2.00; and it is considered very good with a coefficient of.90 or higher and an index of 3.00 (Bond & Fox, [<reflink idref="bib1" id="ref29">1</reflink>]).</p> <hd id="AN0161419910-7">Results</hd> <p></p> <hd id="AN0161419910-8">Fitness of the Items</hd> <p>This study analysed the fitness of the items of each part, using the infit and outfit indices of the unidimensional model of the SFA. Part I did not have any misfitting items. Part II had two misfitting items in the cognitive/behavioural tasks and did not have misfitting items in the physical tasks (Table 2). In Part III, 14 out of 171 items of the 12 scales of physical activities were misfitting, but the scales of 'manipulation with movement' and 'using materials' did not have any misfitting items. In the cognitive/behavioural task of Part III, 12 out of 121 items of the 9 scales were misfitting (Table 3).</p> <p>Table 2. Misfitting items identified by Rasch fit statistics (Part ІІ).</p> <p> <ephtml> <table><thead><tr><td>Scale</td><td>Item number and content</td><td>Infit</td><td>Outfit</td></tr><tr><td>MnSq</td><td>Zstd</td><td>MnSq</td><td>Zstd</td></tr></thead><tbody><tr><td>Cognitive /behavioural task</td><td>Personal care awareness</td><td>1.45</td><td>2.97</td><td>1.45</td><td>2.97</td></tr><tr><td>Safety</td><td>1.52</td><td>3.28</td><td>1.39</td><td>2.39</td></tr></tbody></table> </ephtml> </p> <p>Table 3. Misfitting items identified by Rasch fit statistics (Part III).</p> <p> <ephtml> <table><thead><tr><td>Scale</td><td>Item number and content</td><td>Infit</td><td>Outfit</td></tr><tr><td>MnSq</td><td>Zstd</td><td>MnSq</td><td>Zstd</td></tr></thead><tbody><tr><td>Physical task</td><td>Travel</td><td>18. Moves around areas surrounding the school, including crossing traffic areas.</td><td>1.65</td><td>3.98</td><td>2.58</td><td>6.37</td></tr><tr><td>19. Moves on slippery surfaces.</td><td>1.06</td><td>.50</td><td>1.90</td><td>4.12</td></tr><tr><td>Maintaining and changing positions</td><td>12. Boards and disembarks from all types of vehicles.</td><td>1.51</td><td>2.66</td><td>1.28</td><td>1.18</td></tr><tr><td>Recreational movement</td><td>11. Plays in high, stable play equipment.</td><td>1.46</td><td>2.86</td><td>1.32</td><td>1.85</td></tr><tr><td>Setup and cleanup</td><td>15. Opens cartons.</td><td>1.87</td><td>5.02</td><td>9.90</td><td>9.91</td></tr><tr><td>Eating and drinking</td><td>4. Carries finger foods to mouth and bites off small pieces.</td><td>1.81</td><td>3.27</td><td>1.45</td><td>1.38</td></tr><tr><td>9. Eats within allotted time.</td><td>1.52</td><td>3.11</td><td>1.49</td><td>2.89</td></tr><tr><td>Hygiene</td><td>9. Cares for toileting needs in timely fashion to avoid soiling.</td><td>1.63</td><td>3.06</td><td>1.43</td><td>1.48</td></tr><tr><td>Clothing management</td><td>13. Secures shoes by tying or using velcro.</td><td>1.71</td><td>4.19</td><td>1.56</td><td>2.67</td></tr><tr><td>Up/down stairs</td><td>1. Moves up and down single step.</td><td>1.94</td><td>2.34</td><td>7.18</td><td>2.53</td></tr><tr><td>6. Walks/moves up and down stairs with regular speed.</td><td>1.84</td><td>3.28</td><td>1.87</td><td>1.69</td></tr><tr><td>Written work</td><td>1. Works from left to right.</td><td>1.41</td><td>2.37</td><td>1.23</td><td>.73</td></tr><tr><td>Computer and equipment use</td><td>2. Works for 1/2 hour at computer without fatigue.</td><td>1.15</td><td>.92</td><td>3.05</td><td>4.78</td></tr><tr><td>6. Inserts and removes diskettes from computer or tape from tape recorder.</td><td>1.19</td><td>1.07</td><td>1.72</td><td>2.28</td></tr><tr><td>Cognitive /behavioural task</td><td>Functional communication</td><td>1. Communicates yes/no, acceptance/refusal, or choice between 2 or more items.</td><td>1.69</td><td>3.13</td><td>2.41</td><td>1.97</td></tr><tr><td>Following social conventions</td><td>2. Displays appropriate behaviour regarding issues of sexuality.</td><td>1.47</td><td>2.73</td><td>1.20</td><td>.88</td></tr><tr><td>Memory and understanding</td><td>3. Demonstrates memory of routines/structures from day to day.</td><td>1.48</td><td>3.08</td><td>1.59</td><td>3.29</td></tr><tr><td>5. Demonstrates memory for directions to/from other areas in/around the school.</td><td>1.50</td><td>3.08</td><td>1.58</td><td>2.74</td></tr><tr><td>Compliance with adult directives</td><td>1. Proceeds as directed when told 'yes' or 'begin'.</td><td>1.37</td><td>2.25</td><td>2.86</td><td>3.02</td></tr><tr><td>2. Cooperates with non-routine commends and directions given by teacher or other responsible adult.</td><td>1.03</td><td>.23</td><td>1.66</td><td>2.08</td></tr><tr><td>3. Cooperates when asked to help with cleanup and other classroom chores.</td><td>.96</td><td>−.21</td><td>2.09</td><td>3.35</td></tr><tr><td>Task behaviour</td><td>15. Asks for help when rules or directions are not clear.</td><td>1.47</td><td>3.00</td><td>1.38</td><td>1.97</td></tr><tr><td>Positive interaction</td><td>5. Demonstrates independence in social participation.</td><td>2.09</td><td>5.90</td><td>2.07</td><td>4.32</td></tr><tr><td>Behaviour regulation</td><td>3. Refrains from provoking others.</td><td>1.28</td><td>1.79</td><td>1.67</td><td>2.39</td></tr><tr><td>Personal care awareness</td><td>7. Wipes self after toileting.</td><td>1.78</td><td>4.61</td><td>1.74</td><td>3.71</td></tr><tr><td>Safety</td><td>2. Reports illness/injury to an adult.</td><td>1.50</td><td>3.08</td><td>1.58</td><td>2.74</td></tr></tbody></table> </ephtml> </p> <hd id="AN0161419910-9">Difficulty of the Items</hd> <p>Items in each scale of the SFA were numbered and listed in order from easy to difficult, according to the difficulty levels assigned when developing the original SFA. In Part I, the easiest item was 'bathroom/toileting', and the most difficult item was 'playground/recess'. In the physical task for Part II, in terms of the scales of both assistance and adaptation, the easiest item was 'eating and drinking', and the most difficult item was 'recreational movement'. In the cognitive/behavioural task of Part II, in the scales of both assistance and adaptation, the easiest item was 'personal care awareness', and the most difficult item was 'task behaviour/completion'. Among the 12 scales in the physical tasks of Part III, 6 scales matched the easiest items and 5 scales matched the most difficult items when developing the SFA. Likewise, among the nine scales of the cognitive/behavioural task, six scales matched the easiest items and five scales matched the most difficult items when developing the SFA. All the items in the 'up/down stairs' scale had the same difficulty level as when developing the SFA (Table 4).</p> <p>Table 4. Item hierarchical order based on the difficulty estimates.</p> <p> <ephtml> <table><thead><tr><td>Scale</td><td>Item hierarchical order</td></tr></thead><tbody><tr><td>Participation</td><td>4 5 6 3 1 2</td></tr><tr><td>Task supports</td><td>Physical Ttsks</td><td>Assistance</td><td>7 2 8 6 9 5 4 1 3</td></tr><tr><td>Adaptations</td><td>7 2 6 8 9 4 5 1 3</td></tr><tr><td>Cognitive /behaviour-al tasks</td><td>Assistance</td><td>8 4 3 2 9 1 7 6 5</td></tr><tr><td>Adaptations</td><td>8 4 2 3 9 1 7 6 5</td></tr><tr><td>Activity performance</td><td>Physical tasks</td><td>Travel</td><td>7 1 5 4 3 6 2 8 12 9 11 13 10 14 15 19 16 18 17</td></tr><tr><td>Maintaining and changing positions</td><td>6 10 8 5 4 3 11 12 9 7 2 1</td></tr><tr><td>Recreational movement</td><td>1 3 7 5 6 2 4 8 9 11 10</td></tr><tr><td>Manipulation with movement</td><td>2 3 1 9 5 7 10 6 11 4 8 12 13 14 16 15</td></tr><tr><td>Using materials</td><td>1 3 5 2 6 9 8 4 10 12 7 19 22 11 20 21 14 17 24 23 13 16 15 18 25</td></tr><tr><td>Setup and cleanup</td><td>3 4 9 1 2 10 5 8 6 7 13 11 12 16 15 14</td></tr><tr><td>Eating and drinking</td><td>2 1 5 3 4 7 6 13 10 12 11 8 14 9</td></tr><tr><td>Hygiene</td><td>5 6 3 12 8 4 2 9 10 7 13 1 11 14 15</td></tr><tr><td>Clothing management</td><td>1 8 5 12 3 11 7 2 10 4 6 9 13 15 14 17 16</td></tr><tr><td>Up/down stairs</td><td>1 2 3 4 5 6</td></tr><tr><td>Written Work</td><td>1 2 3 5 4 7 6 9 11 8 10 12</td></tr><tr><td>Computer and equipment use</td><td>1 2 5 3 4 6 7 8</td></tr><tr><td>Cognitive /behaviour-al tasks</td><td>Functional communication</td><td>2 3 4 5 1 7 6 8 10 9 11 12 13</td></tr><tr><td>Following social conventions</td><td>6 2 1 5 3 4 8 7 10 11 9 12</td></tr><tr><td>Memory and understanding</td><td>1 4 2 5 7 6 3 9 10 8</td></tr><tr><td>Compliance with adult directives</td><td>1 2 4 7 3 6 5 9 10 8 15 11 13 12 14</td></tr><tr><td>Task behaviour</td><td>1 2 6 3 4 5 10 11 7 9 8 15 13 18 17 16 12 19 14</td></tr><tr><td>Positive interaction</td><td>1 3 4 2 5 8 6 7 9 14 11 10 13 12 15 17 16 20 18 19</td></tr><tr><td>Behaviour regulation</td><td>4 3 1 2 5 10 8 7 6 11 9 12</td></tr><tr><td>Personal care awareness</td><td>1 2 6 4 5 3 7 8 9 10</td></tr><tr><td>Safety</td><td>1 4 2 3 6 5 7 8 9 10</td></tr></tbody></table> </ephtml> </p> <p>1 Note: Items are listed in order of increasing difficulty, and the number of items represents the difficulty level at the time of SFA development.</p> <hd id="AN0161419910-10">Analysis of the Rating Scales</hd> <p>According to the analysis of rating scales for each part of the SFA, for the 6-point rating scale of Part I, outfit MnSq values were lower than 2.0 and the observed average and step calibration scores monotonically increased, but some of the step calibration intervals were lower than 1.0 logits. Therefore, the 6-point rating scale was considered inappropriate (Table 5, Figure 1). Based on first observed estimates, this study changed the 6-point rating scale into a 5-point rating scale by combining the fourth and fifth points, which had the closest interval. However, because the step calibration intervals were still smaller than 1.0 logits, the 5-point rating scale was also considered inappropriate.</p> <p>Table 5. Six-category rating scale statistics (Part I).</p> <p> <ephtml> <table><thead><tr><td>Category label</td><td>Observed count</td><td>%</td><td>Observed average</td><td>Infit MnSq</td><td>Outfit MnSq</td><td>Step calibration</td></tr></thead><tbody><tr><td>1</td><td>50</td><td>8</td><td>−1.52</td><td>1.43</td><td>1.32</td><td>None</td></tr><tr><td>2</td><td>75</td><td>12</td><td>−.84</td><td>1.12</td><td>1.11</td><td>−1.74</td></tr><tr><td>3</td><td>190</td><td>31</td><td>−.13</td><td>.78</td><td>.72</td><td>−1.34</td></tr><tr><td>4</td><td>91</td><td>15</td><td>.70</td><td>1.01</td><td>1.01</td><td>.98</td></tr><tr><td>5</td><td>95</td><td>15</td><td>1.01</td><td>1.06</td><td>1.02</td><td>.80</td></tr><tr><td>6</td><td>117</td><td>19</td><td>1.88</td><td>.91</td><td>.94</td><td>1.30</td></tr></tbody></table> </ephtml> </p> <p>Graph: Figure 1. 6-category probability curves (Part I).</p> <p>Based upon the second observed estimates, this study converted the 6-point rating scale into a 4-point rating scale by combining the second and third points and the fourth and fifth points, respectively. A few of the step calibration intervals still had a value smaller than 1.0 logits; the 4-point rating scale was therefore also considered inappropriate. Finally, based on the first and second observed estimates, this study changed the 6-point rating scale into a 4-point rating scale by combining the first and second points and the fourth and fifth points, respectively. The analysis results revealed that the outfit MnSq values were smaller than 2.0; the observed average and step calibration scores showed a monotonically increasing pattern; and the step calibration intervals ranged from 1.0 to 5.0 logits. This 4-point rating scale was therefore judged appropriate (Table 6, Figure 2). In sum, for Part I of the SFA, a 4-point rating scale clearly distinguished responses between scales.</p> <p>Table 6. Modified 4-category rating scale statistics (Part I).</p> <p> <ephtml> <table><thead><tr><td>Category label</td><td>Observed count</td><td>%</td><td>Observed average</td><td>Infit MnSq</td><td>Outfit MnSq</td><td>Step calibration</td></tr></thead><tbody><tr><td>1</td><td>125</td><td>20</td><td>−2.23</td><td>1.38</td><td>1.40</td><td>None</td></tr><tr><td>2</td><td>190</td><td>31</td><td>−.82</td><td>.79</td><td>.74</td><td>−2.00</td></tr><tr><td>3</td><td>186</td><td>30</td><td>.73</td><td>.89</td><td>.92</td><td>.05</td></tr><tr><td>4</td><td>117</td><td>19</td><td>2.29</td><td>.95</td><td>.96</td><td>1.95</td></tr></tbody></table> </ephtml> </p> <p>Graph: Figure 2. Modified 4-category probability curves (Part I).</p> <p>The results of the analysis of 4-point rating scales for the physical and cognitive/behavioural tasks on Part II showed that the scales for both the tasks were appropriate. The analysis revealed that: the outfit MnSq values were smaller than 2.0; the observed average and step calibration scores showed a monotonically increasing pattern; and the step calibration intervals ranged from 1.0 to 5.0 logits.</p> <p>This study then conducted an analysis of the 4-point rating scales for the 12 scales of Part III. Of the 12 scales, 4 – 'maintaining and changing positions', 'clothing management', 'up/down stairs', and 'computer and equipment use' – were found to be inappropriate, but the other 8 were considered appropriate. A 3-point rating scale, which combined the third and fourth points, was found appropriate for three of the four scales: 'maintaining and changing positions', 'clothing management', and 'up/down stairs'. A 3-point rating scale that combined the second and third points was appropriate for the scale of 'computer and equipment use'. The 4-point rating scale was considered appropriate for the nine scales of the cognitive/behavioural tasks of Part III since this scale satisfied all the criteria.</p> <hd id="AN0161419910-11">Separation Reliability</hd> <p>This study then analysed the results of separation reliability for the person and item in each part. In Part I, participation, for a person, the value of separation reliability was.85 and the separation index was 2.38; the separation reliability for an item was.96, and the separation index was 5.11. In Part II, task support, the value of separation reliability of a person was.93 and the separation index for a person was 3.79; for an item, the separation reliability was.96 and the separation index was 5.08. For the physical task in Part III, activity performance, the value of separation reliability for a person was.98 and separation index for a person was 8.08; for an item, the separation reliability was.98, and the separation index was 7.09. Finally, for the cognitive/behavioural task in Part III, the value for person separation reliability was.99, and the person separation index was 9.48; for item, the separation reliability was.98, and separation index was 7.25 (Table 7). The person separation reliability for Part I was 'good', and the person and item separation reliabilities for Parts II and III were 'very good', as was the item separation reliability for Part I.</p> <p>Table 7. Separation reliability of person and item.</p> <p> <ephtml> <table><thead><tr><td /><td>SE</td><td>Separation index</td><td>Separation reliability</td></tr></thead><tbody><tr><td>Participation</td><td>Person</td><td>.12</td><td>2.38</td><td>.85</td></tr><tr><td>Item</td><td>.24</td><td>5.11</td><td>.96</td></tr><tr><td>Task supports</td><td>Person</td><td>.13</td><td>3.79</td><td>.93</td></tr><tr><td>Item</td><td>.16</td><td>5.08</td><td>.96</td></tr><tr><td>Activity performance</td><td>Physical tasks</td><td>Person</td><td>.10</td><td>8.08</td><td>.98</td></tr><tr><td>Item</td><td>.09</td><td>7.09</td><td>.98</td></tr><tr><td>Cognitive /behavioural tasks</td><td>Person</td><td>.16</td><td>9.48</td><td>.99</td></tr><tr><td>Item</td><td>.10</td><td>7.25</td><td>.98</td></tr></tbody></table> </ephtml> </p> <p>2 Note: SE = standard error.</p> <hd id="AN0161419910-12">Discussion</hd> <p>In accordance with the <emph>Special Education Laws for Persons with Disabilities and Others</emph>, revised in 2007, Korea has implemented school-based occupational therapy to provide therapeutic support services in school environments. Standardised evaluation tools are needed to measure functional task performance and school activities in order to provide appropriate school-based occupational therapy services for students who need special education in school settings (Muhlenhaupy, [<reflink idref="bib20" id="ref30">20</reflink>]). To meet this need, the SFA is a good evaluation tool for use in schools. The SFA is a criterion-based instrument to facilitate collaborative program planning as it relates to elementary school students with disabilities (Strein & Kuhn-McKearin, [<reflink idref="bib25" id="ref31">25</reflink>]). The SFA has proven reliability and validity, but studies of the SFA have focused more on its usefulness for evaluating students with physical or sensory disabilities (Strein & Kuhn-McKearin, [<reflink idref="bib25" id="ref32">25</reflink>]). More research is needed to effectively adapt the SFA for use in various cultures, languages, and subjects. In the Korean context specifically, studies should consider the application of the SFA for students with intellectual disabilities or autism spectrum disorders, since school-based occupational therapists meet frequently with these students. The present study therefore analysed the validity of the SFA when applied to Korean students who need school-based occupational therapy, a large proportion of whom have intellectual disabilities or autism spectrum disorders. The present study used Rasch analysis to evaluate the SFA, including the fitness of the items, the difficulty of the items, the fitness of the rating scales, and separation reliability.</p> <p>The present study examined the fitness of each part of the SFA. Part I did not include any misfitting items. However, Part II had two misfitting items, one of which was in the cognitive/behavioural tasks. In Part III, there were 14 misfitting items in the physical tasks, and 12 misfitting items in the cognitive/behavioural tasks. In another study, Park ([<reflink idref="bib21" id="ref33">21</reflink>]) similarly reported 18 misfitting items for the physical tasks and 14 misfitting items for the cognitive/behavioural tasks in Part III. However, Hwang et al. ([<reflink idref="bib9" id="ref34">9</reflink>]) found only 5 misfitting items in the cognitive behavioural task, and 9 misfitting items in the cognitive/behavioural tasks in their study of 35 children with cerebral palsy or a learning disability and 29 children without disabilities. Only 1 of the 14 misfitting items found by Hwang et al. ([<reflink idref="bib9" id="ref35">9</reflink>]) is consistent with the results of this study. This indicates that misfitting analysis results may differ depending on the context of the student's school environment (their country or culture) and type of disability. The context of the student's school environment should therefore be carefully considered when interpreting and applying misfitting results.</p> <p>Coster ([<reflink idref="bib5" id="ref36">5</reflink>]) used a Rasch analysis to determine the difficulty of SFA items and subsequently arranged them in order of difficulty. Hwang and Davies ([<reflink idref="bib10" id="ref37">10</reflink>]) used a similar order of difficulty to that of the original SFA. Both studies included students in special education and students in general education (Coster, Deeney, Haltiwanger, & Haley, [<reflink idref="bib6" id="ref38">6</reflink>]; Hwang & Davies, [<reflink idref="bib10" id="ref39">10</reflink>]). In contrast, this study arranged items differently than the original SFA. In the present study the 'up/down stairs scale' is the only scale in which items are organised with the same item difficulty as the original SFA. In this study, item 1 in the 'maintaining and changing positions' scale of the physical task of Part III was considered the most difficult by participants, but was considered the easiest during the development of the SFA. The reason for this difference may be that Korean students who need school-based occupational therapy are very different from those in the United States. In the development and standardisation of the original SFA, 363 special education students and 315 general education students participated, and the special education students had severe physical or sensory difficulties (Coster et al., [<reflink idref="bib6" id="ref40">6</reflink>]). In the Korean context, however, there is a relatively high proportion (54–69%) of students with intellectual disabilities (Park, [<reflink idref="bib21" id="ref41">21</reflink>]; Shin, Park, Lee, & Park, [<reflink idref="bib24" id="ref42">24</reflink>]). The percentage of Korean students in special education with intellectual disabilities is 53.7%, followed by 13.4% who have autism spectrum disorder. Out of the total number of students receiving special education in Korea, 47.7% receive therapeutic support services (Ministry of Education, [<reflink idref="bib19" id="ref43">19</reflink>]). Because of their strong individual differences, various disability characteristics, and limits in accessing adequate education in general schools, students with severe disabilities are most likely to prefer special schools, designed to educate students with where only students with disabilities. Students with severe disabilities are treated in hospitals or clinics instead of using government-provided vouchers to receive therapeutic support in school (Jo, [<reflink idref="bib11" id="ref44">11</reflink>]). In Korea, preschool or elementary school children with intellectual or mild physical disabilities, not major physical or sensory disabilities, use school-based occupational therapy (Kim & Kim, [<reflink idref="bib12" id="ref45">12</reflink>]). Children with intellectual disabilities experience different degrees of difficulty performing various tasks compared to children without disabilities or those with physical disabilities. This study shows that the difficulty of the SFA used in this research differed from the difficulty of the original SFA. It was, therefore, necessary to modify the SFA to fit Korean students, rather than apply the original one.</p> <p>According to the analysis of the rating scales: the 6-point rating scale for Part I was inappropriate, and the 4-point rating scale that combined the first and second points and the fourth and fifth points was appropriate. In the physical tasks of Part III, the modified 3-point scale was considered appropriate for four of the scales, and an existing 4-point rating scale was considered appropriate for the other scales. These results can be used as a basis for rating scales in future Korean versions of the SFA.</p> <p>Person and item separation reliabilities were good or very good, with coefficients ranging from.85 to.99. In general, the larger the number of items, the higher the person separation index, and the larger the number of participants, the higher the item separation index (Linacre, [<reflink idref="bib18" id="ref46">18</reflink>]).</p> <p>The original SFA focuses on functional areas particularly necessary for students with physical or sensory disabilities (Strein & Kuhn-McKearin, [<reflink idref="bib25" id="ref47">25</reflink>]). It is better suited to evaluate the non-educational functions of children with severe motor disabilities, such as cerebral palsy (Sakzewski et al., [<reflink idref="bib23" id="ref48">23</reflink>]). Some research has suggested that the SFA might not be the best choice to evaluate the adaptive behaviour – such as school functions – of students who do not have severe motor disorders (e.g., those with autism) (Piersel, [<reflink idref="bib22" id="ref49">22</reflink>]; Strein & Kuhn-McKearin, [<reflink idref="bib25" id="ref50">25</reflink>]). Studies that have evaluated the reliability and validity of the SFA in different cultural contexts have also focused on children with more serious motor disorders, like cerebral palsy (Hwang et al., [<reflink idref="bib9" id="ref51">9</reflink>]; Li et al., [<reflink idref="bib16" id="ref52">16</reflink>]). In order to use the SFA to evaluate children who have intellectual disabilities or autism spectrum disorders, rather than physical disabilities, the SFA requires modification or supplementation.</p> <p>This study is valuable because it adapts the SFA for use on Korean students who need school-based occupational therapy, the majority of whom have intellectual disabilities. To do this, the present study verified the fitness of SFA items, the difficulty of these items, the fitness of the rating scales, and the separation reliability of the SFA. However, since the participants of this study were mainly concentrated in the lower grades, the school functions of all grades were not evaluated. Future studies will need to further expand the range of participants.</p> <p>In Korea, students who need school-based occupational therapy are different from the target group used to develop the original SFA. In order to adjust the SFA to more accurately assess the school function of students in the Korean context, it is necessary to modify the misfitting items, items' difficulty, and the rating scales of the SFA. The present study can be used as a base for this analysis. The suggestions in this study – that the SFA requires adaptation to accurately evaluate student's in different national and cultural contexts – are applicable, not only in Korea, but in other cultures and countries as well. In order to effectively use the SFA in different countries, it is necessary to consider the context in which the original SFA was developed, and consider the educational situation (including students disabilities) in a specific country to appropriately modify or supplement the SFA.</p> <hd id="AN0161419910-13">Disclosure Statement</hd> <p>No potential conflict of interest was reported by the authors.</p> <ref id="AN0161419910-14"> <title> References </title> <blist> <bibl id="bib1" idref="ref16" type="bt">1</bibl> <bibtext> Bond, T. G., & Fox, C. M. (2015). Applying the Rasch model: Fundamental measurement in the human sciences (3rd ed. ed.). Mahwah, NJ : Lawrence Erlbaum.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref1" type="bt">2</bibl> <bibtext> Case-Smith, J., & O'Brien, J. C. (2010). Occupational therapy for children (6th ed. ed.). St. Louis, MO : Mosby.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref27" type="bt">3</bibl> <bibtext> Chi, E., & Chae, S. H. (2000). 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  Data: Reliability and Validity of the School Function Assessment for Children with Disabilities in Korea: Applying Rasch Analysis
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  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Kim%2C+Hun+Ju%22">Kim, Hun Ju</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-0900-5663">0000-0002-0900-5663</externalLink>)<br /><searchLink fieldCode="AR" term="%22Lee%2C+Sung+Ja%22">Lee, Sung Ja</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-9411-1091">0000-0001-9411-1091</externalLink>)<br /><searchLink fieldCode="AR" term="%22Kam%2C+Kyung-Yoon%22">Kam, Kyung-Yoon</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-0387-1843">0000-0002-0387-1843</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22International+Journal+of+Disability%2C+Development+and+Education%22"><i>International Journal of Disability, Development and Education</i></searchLink>. 2023 70(1):32-44.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 13
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2023
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Elementary+Education%22">Elementary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Test+Validity%22">Test Validity</searchLink><br /><searchLink fieldCode="DE" term="%22Test+Reliability%22">Test Reliability</searchLink><br /><searchLink fieldCode="DE" term="%22Occupational+Therapy%22">Occupational Therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Students+with+Disabilities%22">Students with Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Elementary+School+Students%22">Elementary School Students</searchLink><br /><searchLink fieldCode="DE" term="%22Test+Items%22">Test Items</searchLink><br /><searchLink fieldCode="DE" term="%22Difficulty+Level%22">Difficulty Level</searchLink><br /><searchLink fieldCode="DE" term="%22Rating+Scales%22">Rating Scales</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Disabilities%22">Physical Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Ability%22">Ability</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22South+Korea%22">South Korea</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/1034912X.2020.1870665
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1034-912X<br />1465-346X
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: This study verified validity and reliability of the School Function Assessment (SFA) using Rasch analysis in South Korean school-based occupational therapy sites serving children with intellectual disabilities and others. Participants were 103 elementary school children (grades 1 through 6) with disabilities. Rasch analysis revealed several misfitting items. Difficulty levels of items, presented in hierarchical order, were very different from those found at the time of development of the SFA. Results for the rating scale fit showed that a 4-point scale, rather than the existing 6-point scale, was more appropriate for several parts of the SFA in the Korean context. Separation reliability ranged from good to very good, with coefficients from 0.85 to 0.99. This study contributes to the literature by verifying the reliability and validity of the SFA for students who need school-based occupational therapy in Korea using Rasch analysis, with a focus on applying it to children with intellectual disabilities and autistic spectrum disorders. For more efficient application of the SFA in South Korea in the future, it remains necessary to modify the misfitting items, rearrange their difficulty levels, and properly adjust the rating scales rather than evaluating items by literally translating them into Korean.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2023
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1376870
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1376870
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/1034912X.2020.1870665
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 13
        StartPage: 32
    Subjects:
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Test Validity
        Type: general
      – SubjectFull: Test Reliability
        Type: general
      – SubjectFull: Occupational Therapy
        Type: general
      – SubjectFull: Students with Disabilities
        Type: general
      – SubjectFull: Intellectual Disability
        Type: general
      – SubjectFull: Elementary School Students
        Type: general
      – SubjectFull: Test Items
        Type: general
      – SubjectFull: Difficulty Level
        Type: general
      – SubjectFull: Rating Scales
        Type: general
      – SubjectFull: Symptoms (Individual Disorders)
        Type: general
      – SubjectFull: Physical Disabilities
        Type: general
      – SubjectFull: Ability
        Type: general
      – SubjectFull: South Korea
        Type: general
    Titles:
      – TitleFull: Reliability and Validity of the School Function Assessment for Children with Disabilities in Korea: Applying Rasch Analysis
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Kim, Hun Ju
      – PersonEntity:
          Name:
            NameFull: Lee, Sung Ja
      – PersonEntity:
          Name:
            NameFull: Kam, Kyung-Yoon
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          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2023
          Identifiers:
            – Type: issn-print
              Value: 1034-912X
            – Type: issn-electronic
              Value: 1465-346X
          Numbering:
            – Type: volume
              Value: 70
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: International Journal of Disability, Development and Education
              Type: main
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