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When assessing the psychometric qualities of questionnaires, performance tests or observational

instruments, missing values are a common problem. In the presence of structural and non-structural
missing data, the problem becomes more complex and several methods of handling the missing data
can be applied. In this thesis we considered the following five methods within a Rasch framework: a)
treating missing values as fails (MAF); b) treating non-structural missing values by full information
maximum likelihood (FIML) and structural missing values as fails (FIML-MAF); c) treating all
missing values by FIML (FIML); d) treating non-structural missing values by plausible value multiple
imputation (PVMI) and structural missing values as fails (PVMI-MAF), and e) treating missing values
by PVMI (PVMI). To get insight into the impact of these methods on the assessment of psychometric
properties of an instrument, we applied them to binary (pass/fail) data gathered in children with
cerebral visual impairment (CVI) with the Visual Assessment Scale (VAS). Children with CVI often
are often unable to follow instructions, resulting in a large amount of non-structural missing values for
the VAS The VAS items are divided across six levels of visual ability and items in a higher level of
visual ability are assumed to have a higher difficulty (based on theoretical background). The structural
missing values of the VAS are a result of raters no longer rating items once a patient does not pass the
majority of items in a certain level of visual functioning. Patients who cannot pass items in certain
level of visual functioning, should not be able to pass items in a higher level of visual functioning. The
difficulty parameters, item, person and model fit and internal consistency were compared to assess the
psychometric properties of the VAS under the five different methods for handling missing data. The
theoretical framework of the VAS was used to compare item difficulty misfit.

The results indicate that treating non-structural missing values as fails leads to worse item, person and
model fit than treating these missing values with a model-based imputation method such as PVMI or
FIML. For structural missing values on items that were completed by only few patients, the item
difficulties were substantially lower when applying a model-based imputation method (FIML/PVMI)
than when replacing these missing values with fails (MAF/FIML-MAF/PVMI-MAF). This resulted in
item difficulties that differed from the theoretically assigned difficulty (i.e. they required less visual
ability than assumed), when applying PVMI and FIML methods for handling missing data. However,
we do not know what the true difficulty parameters are. This means that we cannot say that replacing
structural missing values with fails improves the difficulty parameter estimation, unless the a priori
assumptions we make about the increasing item difficulty holds. If this assumption does hold (i.e. the
true difficulty parameters are known and increase in difficulty), then treating structural missing values
as fail will be a solution for treating missing data. The choice of which method should be used thus
depends largely on the assumptions that are made about the questionnaire/instrument prior to assessing
the psychometric qualities of the instrument.