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Development of the multiple sclerosis (MS) early mobility impairment questionnaire (EMIQ)

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Abstract

The Early Mobility Impairment Questionnaire (EMIQ) was developed to facilitate early identification of mobility impairments in multiple sclerosis (MS) patients. We describe the initial development of the EMIQ with a focus on the psychometric evaluation of the questionnaire using classical and item response theory methods. The initial 20-item EMIQ was constructed by clinical specialists and qualitatively tested among people with MS and physicians via cognitive interviews. Data from an observational study was used to make additional updates to the instrument based on exploratory factor analysis (EFA) and item response theory (IRT) analysis, and psychometric analyses were performed to evaluate the reliability and validity of the final instrument’s scores and screening properties (i.e., sensitivity and specificity). Based on qualitative interview analyses, a revised 15-item EMIQ was included in the observational study. EFA, IRT and item-to-item correlation analyses revealed redundant items which were removed leading to the final nine-item EMIQ. The nine-item EMIQ performed well with respect to: test–retest reliability (ICC = 0.858); internal consistency (α = 0.893); convergent validity; and known-groups methods for construct validity. A cut-point of 41 on the 0-to-100 scale resulted in sufficient sensitivity and specificity statistics for viably identifying patients with mobility impairment. The EMIQ is a content valid and psychometrically sound instrument for capturing MS patients’ experience with mobility impairments in a clinical practice setting. Additional research is suggested to further confirm the EMIQ’s screening properties over time.

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Author information

Authors and Affiliations

  1. Center of Clinical Neuroscience, Neurological University Clinic Carl Gustav Carus, TU Dresden, Germany

    Tjalf Ziemssen

  2. Adelphi Values USA, Boston, MA, USA

    Adam Mathias, Catherine Foley, Cheryl Coon & Rohini Sen

  3. University of Mississippi, University, MS, USA

    Ruchit Shah

  4. Biogen, Cambridge, MA, USA

    Glenn Phillips, Andrew Lee & Sonalee Agarwal

Authors
  1. Tjalf Ziemssen
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  2. Glenn Phillips
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  3. Ruchit Shah
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  4. Adam Mathias
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  5. Catherine Foley
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  6. Cheryl Coon
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  7. Rohini Sen
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  8. Andrew Lee
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  9. Sonalee Agarwal
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Corresponding author

Correspondence to Andrew Lee.

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Conflicts of interest

T Ziemssen has received personal compensation for participating on advisory boards, trial steering committees and data and safety monitoring committees as well as for scientific talks and project support from: Bayer HealthCare, Biogen Idec, Elan, Genzyme, Merck Serono, Novartis, Roche, Sanofi-Aventis, Synthon and Teva. G Phillips and A Lee are currently employed by Biogen who provided financial support for research. A Mathias was employed by Adelphi Values at the time of research, which received payment from Biogen to assist with the research process. C Coon was employed at the time of research by Adelphi Values, which received payment from Biogen to assist with the research process. C Foley and R Sen are currently employed by Adelphi Values, which received payment from Biogen to assist with the research process.

Design, conduct, and financial support for this research were provided by Biogen. Biogen participated in the interpretation of data, review, and approval of the manuscript. All authors contributed to the development of the publication and maintained control over the final content.

Ethical standards

This study was conducted in accordance with the British Healthcare Business Intelligence Association (BHBIA) Legal and Ethical Framework (Dec 2012 Legal and Ethical guidelines for Healthcare MR), Association of the British Pharmaceutical Industry (ABPI) Code of Conduct, ABPI Adverse Event Guidelines (April 2013), and Data Protection legislation.

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Ziemssen, T., Phillips, G., Shah, R. et al. Development of the multiple sclerosis (MS) early mobility impairment questionnaire (EMIQ). J Neurol 263, 1969–1983 (2016). https://doi.org/10.1007/s00415-016-8210-4

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  • DOI: https://doi.org/10.1007/s00415-016-8210-4

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