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According to the polychoric correlations matrix, all items except diurnal variation (item 2) and constipation (item 8), presented high intercorrelations with items within the same factor (Table 2).
This questionnaire has several subscales and we analyzed subscales as follows: item 1-3 (10-point-Likert scales), item 4 (four figures of pain symptom variation), item 5 (yes/no to symptoms of radiating pain), item 6 (average value of seven 5-point-Likert scales) as well as a total painDETECT score.
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An average of 8 patients (SD = 1) failed to complete each one of the seventeen items with scarce variation among items (range: 7/10 items).
When stimuli in an experimental condition are sampled from a universe of natural items, some variation among items will always be present.
However, again in line with our previous findings [ 15] there was some variation between items, with items 4 (whole-person approach) and 10 (shared plan of action) having the highest percentages of 'not applicable' responses and the lowest ratings of importance.
Prior to the refresher session, we reviewed the first 269 results of the neighborhood assessments and found satisfactory variation in item responses.
PCA results showed that 57% of the variation of item difficulty hierarchy between diagnostic groups was explained by the symmetric or asymmetric nature of the disorders (figure 3).
These analyses resulted in one component solutions for each condition type that accounted for a large percentage of the total variation in item scores, ranging from 76% to 83%.
At the least, this effect may serve to set a 'level playing field' in which cross-cultural differences are unbiased; although, variation in item interpretation within each group may add overall bias or variability to the set of obtained responses.
The second PCA component explained 28% of the variation of item difficulty hierarchy between diagnostic groups and distinguished patients expressing greater difficulties with proximal activities, such as NMD and CP, from more distal disorders such as SSc.
One could argue that some variation in item difficulty levels is preferable, since this result in a scale that is able to assess FOF in individuals with both low and high levels of FOF.
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Since I tried Ludwig back in 2017, I have been constantly using it in both editing and translation. Ever since, I suggest it to my translators at ProSciEditing.

Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com