{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:24:49Z","timestamp":1787757889955,"version":"build-2784847793"},"reference-count":53,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Health-related quality of life is a key secondary end point in stroke trials. Differential item functioning (DIF) occurs when individuals with the same underlying health-related quality of life interpret and respond differently to questionnaire items, potentially biasing treatment comparisons. This study evaluates DIF in the patient-reported 5-level EuroQOL questionnaire among patients with acute ischemic stroke across age, sex, and treatment groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Data were from the AcT trial (Alteplase Compared to Tenecteplase), a registry-based randomized comparison of alteplase and tenecteplase conducted at 22 stroke centers across Canada (December 2019\u2013January 2022). Patients with acute ischemic stroke presenting within 4.5 hours of symptom onset and eligible for thrombolysis completed the 5-level EuroQOL questionnaire at 90 days poststroke. DIF was assessed using multigroup graded response models with the Wald-based sweep procedure, which accounts for between-group differences in latent trait distributions. We quantified effect sizes using signed weighted area between curves (sWABC); |sWABC| &lt;0.10=negligible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Of 1577 patients enrolled in the trial, 1264 survived to 90 days with complete 5-level EuroQOL questionnaire data (51.2% tenecteplase; 46.5% female; 30.1% aged \u226580). Omnibus testing revealed significant DIF only for age (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      =86.9,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001); neither sex (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      =31.7,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.063) nor treatment (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      =22.4,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.379) showed evidence of DIF. Four items flagged for age-related DIF: self-care, usual activities, pain\/discomfort, and anxiety\/depression. However, only self-care (sWABC=\u22120.46) and usual activities (sWABC=\u22120.34) showed moderate effects, while pain\/discomfort (sWABC=\u22120.002) and anxiety\/depression (sWABC=0.09) were negligible. Importantly, factor scores from models with and without DIF adjustment correlated (correlation coefficient=0.98).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>The 5-level EuroQOL questionnaire appears to function equivalently across sex and treatment groups in this stroke population. Age-related DIF, though statistically detectable in physical functioning items, had little practical consequence for individual scores, supporting the instrument\u2019s use for health-related quality of life comparisons in stroke trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03889249.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.126.055939","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T09:00:12Z","timestamp":1784797212000},"page":"2653-2660","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating Differential Item Functioning in EQ-5D-5L in Acute Ischemic Stroke: Evidence From the ACT Trial"],"prefix":"10.1161","volume":"57","clinical-trial-number":[{"clinical-trial-number":"nct03889249","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9464-589X","authenticated-orcid":true,"given":"Olayinka I.","family":"Arimoro","sequence":"first","affiliation":[{"name":"Department of Community Health Sciences and O\u2019Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, AB, Canada (O.I.A., M.D.H., B.K.M., T.T.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8412-6246","authenticated-orcid":true,"given":"Ayoola","family":"Ademola","sequence":"additional","affiliation":[{"name":"Division of Cancer Research and Analytics, Cancer Care Alberta, Calgary, Canada (A.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6269-1543","authenticated-orcid":true,"given":"Michael D.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences and O\u2019Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, AB, Canada (O.I.A., M.D.H., B.K.M., T.T.S.)."},{"name":"Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, AB, Canada (M.D.H., B.K.M., T.T.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3466-496X","authenticated-orcid":true,"given":"Bijoy K.","family":"Menon","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences and O\u2019Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, AB, Canada (O.I.A., M.D.H., B.K.M., T.T.S.)."},{"name":"Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, AB, Canada (M.D.H., B.K.M., T.T.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5696-5552","authenticated-orcid":true,"given":"Tolulope T.","family":"Sajobi","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences and O\u2019Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, AB, Canada (O.I.A., M.D.H., B.K.M., T.T.S.)."},{"name":"Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, AB, Canada (M.D.H., B.K.M., T.T.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(21)00252-0"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31179-X"},{"key":"e_1_3_3_4_2","volume-title":"Stroke, cerebrovascular accident","author":"World Health Organization","unstructured":"World Health Organization. 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