Floor and Ceiling Effect
Floor and ceiling effects are psychometric phenomena in which a disproportionately large proportion of respondents achieve the lowest (floor) or highest (ceiling) possible score on a measurement scale. These effects compromise scale reliability and responsiveness, limiting the instrument's ability to distinguish among respondents and detect meaningful change over time. Systematic assessment of floor and ceiling effects is essential for evaluating the psychometric adequacy of health-related quality-of-life scales, functional status measures, and other patient-reported outcomes.
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- McHorney, C. A. (2000). Ten recommendations for measuring health status. Health-Related Quality of Life Outcomes, 2(1), 1-5. · URL
- Terwee, C. B., Bot, S. D., de Bats, M. R., van der Windt, D. A., Knol, D. L., Dekker, J., Bouter, L. M., & de Vet, H. C. (2007). Quality criteria for measurement properties of health status questionnaires. Journal of Clinical Epidemiology, 60(1), 34-42. · DOI 10.1016/j.jclinepi.2006.03.012
- Coon, C. D., & Cappelleri, J. C. (2016). Quantifying ceiling and floor effects in the Quality of Life after Brain Injury (QOLIBRI) scale. Health and Quality of Life Outcomes, 14(1), 135. · URL
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