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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.