The current study has shown that the FIMTM Motor Scale, as applied to a stroke rehabilitation sample, satisfies Rasch model expectations and the unidimensionality assumptions, having accommodated local dependency issues, and by using the partial credit parameterization with re-scored categories. Other analytical pathways gave less ideal solutions, and are consistent with the wide range of solutions found for the scale over the years. Consequently, the development of the Rasch approach in health outcomes can be traced in the history of analysis of the FIMTM, and that development continues to this day.

A survey of the age-sex specific prevalence of joint problems in a population and associated features such as disablement and use of treatment was carried out in 1986 in Calderdale, West Yorkshire, United Kingdom. A postal questionnaire was sent to 25168 households; 87% were returned, representing households containing 42826 people aged 16 years and over. Positive answers to a question about pain, swelling, or stiffness in the joints, neck, or back were given by 10246 subjects, 24% of the population aged 16 years and older, of whom 6181 (60-3%) were women. The rate of reporting ofjoint problems increased markedly with age, from 5% for subjects aged 16-24 years to 54% for those aged 85 years and older. The joint sites most often reported as affected were the knee and the back, with a frequency in the population of about 10%. The increase in joint problems with age was accompanied by an increase in reported morning stiffness of more than half an hour, taking drugs, and disability, but not in reporting seeing a specialist for these conditions. Of those aged 85 years and older who reported joint problems, most also had difficulty or dependence in activities of daily living. The increasing prevalence of joint problems with age has implications for the provision of care, both in the community and in hospitals, especially in view of the aging of the population as a whole. The planning of health services for those with rheumatic disorders needs to take into account the high incidence of joint problems in the population. A survey of disability in the population, which included a postal screening questionnaire asking about joint problems, has allowed us to examine the age-sex specific prevalence of joint symptoms in the population, and to study associated aspects such as the use of treatment and disablement in those reporting problems. This allows further consideration of the implications of an aging population for the provision of care in the community and in hospitals, including the potential need for specialist medical services. MethodsA survey was carried out in 1986 in the population of Calderdale, West Yorkshire, United Kingdom. One of the three main objectives was to study the distribution of joint problems in the population.6 Calderdale is in the Pennines in the north of England, with a population at the 1981 census of 189402. The demographic structure of Calderdale at the census, with 23% of its population aged under 16, 61% aged 16-64, 10% aged 65-74, and 6% aged over 75 years, was virtually identical with that of England and Wales at that time.A two stage methodology was used, similar to that in other surveys of disablement in the population.7 '4 The first stage consisted of a postal questionnaire to every third household in the area, using the domestic rating list as the sampling frame. The sample size was determined by the need to provide meaningful analysis for a rare group in the population, namely those very severely physically disabled aged

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The MFIS cannot be used to generate a single overall score of fatigue. The conceptual interaction between the two dimensions remains unclear, which poses problems when interpreting change scores in these individual scales. Studies in which a global MFIS score was used as either an outcome measure or selection tool may need to be re-evaluated.