須討論之議題 (8/1)

ADLRS-III response letter須澄清之問題
1. 目前的研究目的只有驗證各面向的單向度，研究主題範疇較窄。
    我的想法：加上內在一致性和天花板/地板效應，可加深研究範疇。

2. partial domain的解讀是否有誤?
    我的想法：partial domain是指CFA適配度良好的面向是否可以單獨使用。

3. Level of disability的內容是否要保留?
    我的想法：目前所提供的level of disability是來自身心障礙證明上的等級，但身心障礙證明的鑑定僅適用於台灣，且自2012年，評定的方式有改，因此我認為不合適保留level of disability的資料。

4. 不管是ordinal 或nominal都可用DWLS估計法。目前的寫法是說明本研究的資料是ordinal，所以使用DWLS估計法，若是資料為nominal，亦為使用DWLS估計法。此寫法合適嗎?
     我的想法：明確地告知審稿者不同資料應該使用的估計法。

5. 須提出每個CFA不好domain，使用modification index (MI)後所刪掉多少項目嗎?
     我的想法：不須，應須明確說明我們不用MI的裡由。

6. 回覆CFA不好domain，沒繼續驗證內在一致性和天花板/地板效應的理由是否清楚?
   我的寫法：CFA適配結果不佳，表示此面向項目不符合單向度，呈現此面向的內在一致性和天花板/地板效應的意義有限。CFA適配結果良好的面向，本研究驗證內在一致性和天花板/地板效應以進一步支持此面向之心理計量特性。
    英文內容如下：We agree with the reviewer that validity testing is based on reliability. However, our results showed that the construct validity (unidimensionality) was not supported in the 6 domains. That is, the items of the individual domain could not be used to assess a single underlying construct. For these 6 domains, the value is limited for reporting reliability (i.e., Cronbach's alpha) and item descriptive analyses before validity testing (i.e., CFA). For the other 4 domains with good model fit, we provided the reliability and item descriptive analyses to further support the psychometric properties of these 4 domains.

7. 本篇研究對護理人員的臨床應用是否仍薄弱?
    我的寫法：特別強調護理人員可使用CFA適配結果良好面向之項目總分，以確定個案之ADL功能，發展治療計畫，並追蹤個案之ADL狀態。此外，護理人員可使用測量分數和其他專業人員溝通。
   英文內容如下：Nurses can use the sum scores of these 4 domains which represent its domain-specific function to identify patients’ ADL functions, develop treatment plans, and follow-up patients’ ADL status. Moreover, nurses can use the scores to communicate and cooperate with other healthcare professionals in a multidisciplinary approach.
 
8. ADLRS-III之重要性與其它工具比較之回覆內容方面，我嘗試說明常用的其它ADL評估工具的部分項目在台灣比較不常使用，而ADLRS-III有針對台灣個案的狀況而發展，雖然會限制ADLRS-III只適用於國內，我想目前所投稿的期刊屬於台灣本土期刊，應該還算合適。此外我有說明ADLRS-III的優點，我想有興趣發展或使用ADL評估工具的其它國家，應該會考量此ADLRS-III的項目內容或設計吧。
    英文內容如下：Some ADL tools have been used in patients with schizophrenia in the previous studies, such as the University of California at San Diego Performance-Based Skills Assessment, the Independent Living Skills Survey, and the Functional Remission of General Schizophrenia. However, these three measures have no Chinese version. Furthermore, some items of these measures are culture-specific (e.g., writing a check and using a dishwasher), which are not common used in Taiwanese culture. The ADLRS-III was developed considering the cultural appropriateness for patients living in Taiwan. Moreover, the ADLRS-III has the following three advantages: (1) it was developed for patients with mental illness, especially patients with schizophrenia; (2) it can be administered in a group setting, which can reduce administrative burden; (3) it can confirm the patient’s knowledge and ability to perform the task through writing out examples to show their understanding of the items and the abilities to implement them 13. Therefore, the ADLRS-III has potential for use in both clinical and research settings.