Improved measurement of tinnitus severity: Study of the dimensionality and reliability of the Tinnitus Handicap Inventory

Improved measurement of tinnitus severity: Study of the dimensionality and reliability of the Tinnitus Handicap Inventory

Objective The Tinnitus Handicap Inventory (THI) is widely used in clinical practice and research as a three-dimensional measure of tinnitus severity. Despite extensive use, its factor structure remains unclear. Furthermore, THI can be considered a reliable measure only if Cronbach's alpha coeff...

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Bibliographic Details
Published in:PloS one 2020-08, Vol.15 (8), p.e0237778-e0237778
Main Authors: Gos, Elzbieta, Sagan, Adam, Skarzynski, Piotr H, Skarzynski, Henryk
Format: Article
Language:eng
Subjects:
Biology and Life Sciences
Classical test theory
Clinical medicine
Clinical trials
Diagnosis
Ears & hearing
Evaluation
Factor analysis
Health surveys
Medicine and Health Sciences
Pathology
Patients
Physical Sciences
Physiology
Quality assessment
Quantitative psychology
Questionnaires
Reliability analysis
Reliability aspects
Reliability engineering
Research and Analysis Methods
Robustness
Sigma factor
Social Sciences
Structural reliability
Theory
Tinnitus
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Summary:Objective The Tinnitus Handicap Inventory (THI) is widely used in clinical practice and research as a three-dimensional measure of tinnitus severity. Despite extensive use, its factor structure remains unclear. Furthermore, THI can be considered a reliable measure only if Cronbach's alpha coefficient and Classical Test Theory is used. The more modern and robust Item Response Theory (IRT) has so far not been used to psychometrically evaluate THI. In theory, IRT allows a more precise evaluation of THI's factor structure, reliability, and the quality of individual items. Method There were 1115 patients with tinnitus (556 women and 559 men), aged 19-84 years (M = 51.55; SD = 13.28). The dimensionality of THI was evaluated using several models of Confirmatory Factor Analysis and an Item Response Theory approach. Exploratory non-parametric Mokken scaling was applied to determine a unidimensional and robust scale. Several IRT polytomous models were used to assess the overall quality of THI. Results The bifactor model had the best fit (RMSEA = 0.055; CFI = 0.976; SRMR = 0.040) and revealed one strong general factor and several weak specific factors. Mokken scaling generated a reliable unidimensional scale (Loevinger's H = 0.463). In order to refine THI we propose that five items be removed. The IRT Generalized Partial Credit Model generated good parameters in terms of item location (difficulty), discrimination, and information content of items. Conclusion Our findings support the use of THI to evaluate tinnitus severity in terms of it being a reliable unidimensional scale. However, clinicians and researchers should rely only on its overall score, which reflects global tinnitus severity. To improve its psychometric quality, several refinements of THI are proposed.
ISSN:1932-6203
1932-6203