Dr Alvan Feinstein1 is to be commended for his commentary published in the January 25, 1999 issue of the ARCHIVES. His position that statistical and psychometric methods may not always offer the best approach for clinical appraisal of complex intangible phenomena was clearly and convincingly presented. We concur that clinimetrics is not only significant on its own behalf, but we would argue that it is also an appropriate starting point for statistical scale development. To this end, several of Feinstein's points bear repeated emphasis. First, there is a substantial need to include greater diversity in the development of composite indexes and rating scales. Second, diversity can be greatly enhanced by acknowledging and incorporating the role of clinical knowledge as part of the process of scale development. Third, face and content validity are important aspects of scale development and yet have seldom been specifically appraised or readily apparent in instrument development. These 3 points emphasize the importance of incorporating into our clinical measures the full breadth of the phenomena under study.
Zyzanski SJ, Perloff E. Clinimetrics and Psychometrics Work Hand in Hand. Arch Intern Med. 1999;159(15):1811-1817. doi: