@article {88,
	title = {Assessing self-care and social function using a computer adaptive testing version of the pediatric evaluation of disability inventory},
	journal = {Archives of Physical Medicine and Rehabilitation},
	volume = {89},
	number = {4},
	year = {2008},
	note = {Coster, Wendy JHaley, Stephen MNi, PengshengDumas, Helene MFragala-Pinkham, Maria AK02 HD45354-01A1/HD/NICHD NIH HHS/United StatesR41 HD052318-01A1/HD/NICHD NIH HHS/United StatesR43 HD42388-01/HD/NICHD NIH HHS/United StatesComparative StudyResearch Support, N.I.H., ExtramuralUnited StatesArchives of physical medicine and rehabilitationArch Phys Med Rehabil. 2008 Apr;89(4):622-9.},
	month = {Apr},
	pages = {622-629},
	edition = {2008/04/01},
	abstract = {OBJECTIVE: To examine score agreement, validity, precision, and response burden of a prototype computer adaptive testing (CAT) version of the self-care and social function scales of the Pediatric Evaluation of Disability Inventory compared with the full-length version of these scales. DESIGN: Computer simulation analysis of cross-sectional and longitudinal retrospective data; cross-sectional prospective study. SETTING: Pediatric rehabilitation hospital, including inpatient acute rehabilitation, day school program, outpatient clinics; community-based day care, preschool, and children{\textquoteright}s homes. PARTICIPANTS: Children with disabilities (n=469) and 412 children with no disabilities (analytic sample); 38 children with disabilities and 35 children without disabilities (cross-validation sample). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Summary scores from prototype CAT applications of each scale using 15-, 10-, and 5-item stopping rules; scores from the full-length self-care and social function scales; time (in seconds) to complete assessments and respondent ratings of burden. RESULTS: Scores from both computer simulations and field administration of the prototype CATs were highly consistent with scores from full-length administration (r range, .94-.99). Using computer simulation of retrospective data, discriminant validity, and sensitivity to change of the CATs closely approximated that of the full-length scales, especially when the 15- and 10-item stopping rules were applied. In the cross-validation study the time to administer both CATs was 4 minutes, compared with over 16 minutes to complete the full-length scales. CONCLUSIONS: Self-care and social function score estimates from CAT administration are highly comparable with those obtained from full-length scale administration, with small losses in validity and precision and substantial decreases in administration time.},
	keywords = {*Disability Evaluation, *Social Adjustment, Activities of Daily Living, Adolescent, Age Factors, Child, Child, Preschool, Computer Simulation, Cross-Over Studies, Disabled Children/*rehabilitation, Female, Follow-Up Studies, Humans, Infant, Male, Outcome Assessment (Health Care), Reference Values, Reproducibility of Results, Retrospective Studies, Risk Factors, Self Care/*standards/trends, Sex Factors, Sickness Impact Profile},
	isbn = {1532-821X (Electronic)0003-9993 (Linking)},
	author = {Coster, W. J. and Haley, S. M. and Ni, P. and Dumas, H. M. and Fragala-Pinkham, M. A.}
}
@article {5,
	title = {Efficiency and sensitivity of multidimensional computerized adaptive testing of pediatric physical functioning},
	journal = {Disability \& Rehabilitation},
	volume = {30},
	number = {6},
	year = {2008},
	note = {Allen, Diane DNi, PengshengHaley, Stephen MK02 HD45354-01/HD/NICHD NIH HHS/United StatesNIDDR H133P0001/DD/NCBDD CDC HHS/United StatesResearch Support, N.I.H., ExtramuralEnglandDisability and rehabilitationDisabil Rehabil. 2008;30(6):479-84.},
	pages = {479-84},
	edition = {2008/02/26},
	abstract = {PURPOSE: Computerized adaptive tests (CATs) have efficiency advantages over fixed-length tests of physical functioning but may lose sensitivity when administering extremely low numbers of items. Multidimensional CATs may efficiently improve sensitivity by capitalizing on correlations between functional domains. Using a series of empirical simulations, we assessed the efficiency and sensitivity of multidimensional CATs compared to a longer fixed-length test. METHOD: Parent responses to the Pediatric Evaluation of Disability Inventory before and after intervention for 239 children at a pediatric rehabilitation hospital provided the data for this retrospective study. Reliability, effect size, and standardized response mean were compared between full-length self-care and mobility subscales and simulated multidimensional CATs with stopping rules at 40, 30, 20, and 10 items. RESULTS: Reliability was lowest in the 10-item CAT condition for the self-care (r = 0.85) and mobility (r = 0.79) subscales; all other conditions had high reliabilities (r > 0.94). All multidimensional CAT conditions had equivalent levels of sensitivity compared to the full set condition for both domains. CONCLUSIONS: Multidimensional CATs efficiently retain the sensitivity of longer fixed-length measures even with 5 items per dimension (10-item CAT condition). Measuring physical functioning with multidimensional CATs could enhance sensitivity following intervention while minimizing response burden.},
	keywords = {*Disability Evaluation, Child, Computers, Disabled Children/*classification/rehabilitation, Efficiency, Humans, Outcome Assessment (Health Care), Psychometrics, Reproducibility of Results, Retrospective Studies, Self Care, Sensitivity and Specificity},
	isbn = {0963-8288 (Print)0963-8288 (Linking)},
	author = {Allen, D. D. and Ni, P. and Haley, S. M.}
}
@article {287,
	title = {Measuring physical functioning in children with spinal impairments with computerized adaptive testing},
	journal = {Journal of Pediatric Orthopedics},
	volume = {28},
	number = {3},
	year = {2008},
	note = {Mulcahey, M JHaley, Stephen MDuffy, TheresaPengsheng, NiBetz, Randal RK02 HD045354-01A1/HD/NICHD NIH HHS/United StatesUnited StatesJournal of pediatric orthopedicsJ Pediatr Orthop. 2008 Apr-May;28(3):330-5.},
	month = {Apr-May},
	pages = {330-5},
	edition = {2008/03/26},
	abstract = {BACKGROUND: The purpose of this study was to assess the utility of measuring current physical functioning status of children with scoliosis and kyphosis by applying computerized adaptive testing (CAT) methods. Computerized adaptive testing uses a computer interface to administer the most optimal items based on previous responses, reducing the number of items needed to obtain a scoring estimate. METHODS: This was a prospective study of 77 subjects (0.6-19.8 years) who were seen by a spine surgeon during a routine clinic visit for progress spine deformity. Using a multidimensional version of the Pediatric Evaluation of Disability Inventory CAT program (PEDI-MCAT), we evaluated content range, accuracy and efficiency, known-group validity, concurrent validity with the Pediatric Outcomes Data Collection Instrument, and test-retest reliability in a subsample (n = 16) within a 2-week interval. RESULTS: We found the PEDI-MCAT to have sufficient item coverage in both self-care and mobility content for this sample, although most patients tended to score at the higher ends of both scales. Both the accuracy of PEDI-MCAT scores as compared with a fixed format of the PEDI (r = 0.98 for both mobility and self-care) and test-retest reliability were very high [self-care: intraclass correlation (3,1) = 0.98, mobility: intraclass correlation (3,1) = 0.99]. The PEDI-MCAT took an average of 2.9 minutes for the parents to complete. The PEDI-MCAT detected expected differences between patient groups, and scores on the PEDI-MCAT correlated in expected directions with scores from the Pediatric Outcomes Data Collection Instrument domains. CONCLUSIONS: Use of the PEDI-MCAT to assess the physical functioning status, as perceived by parents of children with complex spinal impairments, seems to be feasible and achieves accurate and efficient estimates of self-care and mobility function. Additional item development will be needed at the higher functioning end of the scale to avoid ceiling effects for older children. LEVEL OF EVIDENCE: This is a level II prospective study designed to establish the utility of computer adaptive testing as an evaluation method in a busy pediatric spine practice.},
	keywords = {*Disability Evaluation, Adolescent, Child, Child, Preschool, Computer Simulation, Cross-Sectional Studies, Disabled Children/*rehabilitation, Female, Humans, Infant, Kyphosis/*diagnosis/rehabilitation, Male, Prospective Studies, Reproducibility of Results, Scoliosis/*diagnosis/rehabilitation},
	isbn = {0271-6798 (Print)0271-6798 (Linking)},
	author = {Mulcahey, M. J. and Haley, S. M. and Duffy, T. and Pengsheng, N. and Betz, R. R.}
}
@article {172,
	title = {Computer adaptive testing improved accuracy and precision of scores over random item selection in a physical functioning item bank},
	journal = {Journal of Clinical Epidemiology},
	volume = {59},
	number = {11},
	year = {2006},
	note = {Haley, Stephen MNi, PengshengHambleton, Ronald KSlavin, Mary DJette, Alan MK02 hd45354-01/hd/nichdR01 hd043568/hd/nichdComparative StudyResearch Support, N.I.H., ExtramuralResearch Support, U.S. Gov{\textquoteright}t, Non-P.H.S.EnglandJournal of clinical epidemiologyJ Clin Epidemiol. 2006 Nov;59(11):1174-82. Epub 2006 Jul 11.},
	month = {Nov},
	pages = {1174-82},
	edition = {2006/10/10},
	abstract = {BACKGROUND AND OBJECTIVE: Measuring physical functioning (PF) within and across postacute settings is critical for monitoring outcomes of rehabilitation; however, most current instruments lack sufficient breadth and feasibility for widespread use. Computer adaptive testing (CAT), in which item selection is tailored to the individual patient, holds promise for reducing response burden, yet maintaining measurement precision. We calibrated a PF item bank via item response theory (IRT), administered items with a post hoc CAT design, and determined whether CAT would improve accuracy and precision of score estimates over random item selection. METHODS: 1,041 adults were interviewed during postacute care rehabilitation episodes in either hospital or community settings. Responses for 124 PF items were calibrated using IRT methods to create a PF item bank. We examined the accuracy and precision of CAT-based scores compared to a random selection of items. RESULTS: CAT-based scores had higher correlations with the IRT-criterion scores, especially with short tests, and resulted in narrower confidence intervals than scores based on a random selection of items; gains, as expected, were especially large for low and high performing adults. CONCLUSION: The CAT design may have important precision and efficiency advantages for point-of-care functional assessment in rehabilitation practice settings.},
	keywords = {*Recovery of Function, Activities of Daily Living, Adolescent, Adult, Aged, Aged, 80 and over, Confidence Intervals, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Outcome Assessment (Health Care)/*methods, Rehabilitation/*standards, Reproducibility of Results, Software},
	isbn = {0895-4356 (Print)},
	author = {Haley, S. M. and Ni, P. and Hambleton, R. K. and Slavin, M. D. and Jette, A. M.}
}
@article {171,
	title = {A computer adaptive testing approach for assessing physical functioning in children and adolescents},
	journal = {Developmental Medicine and Child Neuropsychology},
	volume = {47},
	number = {2},
	year = {2005},
	note = {Haley, Stephen MNi, PengshengFragala-Pinkham, Maria ASkrinar, Alison MCorzo, DeyaniraComparative StudyResearch Support, Non-U.S. Gov{\textquoteright}tEnglandDevelopmental medicine and child neurologyDev Med Child Neurol. 2005 Feb;47(2):113-20.},
	month = {Feb},
	pages = {113-120},
	edition = {2005/02/15},
	abstract = {The purpose of this article is to demonstrate: (1) the accuracy and (2) the reduction in amount of time and effort in assessing physical functioning (self-care and mobility domains) of children and adolescents using computer-adaptive testing (CAT). A CAT algorithm selects questions directly tailored to the child{\textquoteright}s ability level, based on previous responses. Using a CAT algorithm, a simulation study was used to determine the number of items necessary to approximate the score of a full-length assessment. We built simulated CAT (5-, 10-, 15-, and 20-item versions) for self-care and mobility domains and tested their accuracy in a normative sample (n=373; 190 males, 183 females; mean age 6y 11mo [SD 4y 2m], range 4mo to 14y 11mo) and a sample of children and adolescents with Pompe disease (n=26; 21 males, 5 females; mean age 6y 1mo [SD 3y 10mo], range 5mo to 14y 10mo). Results indicated that comparable score estimates (based on computer simulations) to the full-length tests can be achieved in a 20-item CAT version for all age ranges and for normative and clinical samples. No more than 13 to 16\% of the items in the full-length tests were needed for any one administration. These results support further consideration of using CAT programs for accurate and efficient clinical assessments of physical functioning.},
	keywords = {*Computer Systems, Activities of Daily Living, Adolescent, Age Factors, Child, Child Development/*physiology, Child, Preschool, Computer Simulation, Confidence Intervals, Demography, Female, Glycogen Storage Disease Type II/physiopathology, Health Status Indicators, Humans, Infant, Infant, Newborn, Male, Motor Activity/*physiology, Outcome Assessment (Health Care)/*methods, Reproducibility of Results, Self Care, Sensitivity and Specificity},
	isbn = {0012-1622 (Print)},
	author = {Haley, S. M. and Ni, P. and Fragala-Pinkham, M. A. and Skrinar, A. M. and Corzo, D.}
}
@article {168,
	title = {Activity outcome measurement for postacute care},
	journal = {Medical Care},
	volume = {42},
	number = {1 Suppl},
	year = {2004},
	note = {0025-7079Journal ArticleMulticenter Study},
	pages = {I49-161},
	abstract = {BACKGROUND: Efforts to evaluate the effectiveness of a broad range of postacute care services have been hindered by the lack of conceptually sound and comprehensive measures of outcomes. It is critical to determine a common underlying structure before employing current methods of item equating across outcome instruments for future item banking and computer-adaptive testing applications. OBJECTIVE: To investigate the factor structure, reliability, and scale properties of items underlying the Activity domains of the International Classification of Functioning, Disability and Health (ICF) for use in postacute care outcome measurement. METHODS: We developed a 41-item Activity Measure for Postacute Care (AM-PAC) that assessed an individual{\textquoteright}s execution of discrete daily tasks in his or her own environment across major content domains as defined by the ICF. We evaluated the reliability and discriminant validity of the prototype AM-PAC in 477 individuals in active rehabilitation programs across 4 rehabilitation settings using factor analyses, tests of item scaling, internal consistency reliability analyses, Rasch item response theory modeling, residual component analysis, and modified parallel analysis. RESULTS: Results from an initial exploratory factor analysis produced 3 distinct, interpretable factors that accounted for 72\% of the variance: Applied Cognition (44\%), Personal Care \& Instrumental Activities (19\%), and Physical \& Movement Activities (9\%); these 3 activity factors were verified by a confirmatory factor analysis. Scaling assumptions were met for each factor in the total sample and across diagnostic groups. Internal consistency reliability was high for the total sample (Cronbach alpha = 0.92 to 0.94), and for specific diagnostic groups (Cronbach alpha = 0.90 to 0.95). Rasch scaling, residual factor, differential item functioning, and modified parallel analyses supported the unidimensionality and goodness of fit of each unique activity domain. CONCLUSIONS: This 3-factor model of the AM-PAC can form the conceptual basis for common-item equating and computer-adaptive applications, leading to a comprehensive system of outcome instruments for postacute care settings.},
	keywords = {*Self Efficacy, *Sickness Impact Profile, Activities of Daily Living/*classification/psychology, Adult, Aftercare/*standards/statistics \& numerical data, Aged, Boston, Cognition/physiology, Disability Evaluation, Factor Analysis, Statistical, Female, Human, Male, Middle Aged, Movement/physiology, Outcome Assessment (Health Care)/*methods/statistics \& numerical data, Psychometrics, Questionnaires/standards, Rehabilitation/*standards/statistics \& numerical data, Reproducibility of Results, Sensitivity and Specificity, Support, U.S. Gov{\textquoteright}t, Non-P.H.S., Support, U.S. Gov{\textquoteright}t, P.H.S.},
	author = {Haley, S. M. and Coster, W. J. and Andres, P. L. and Ludlow, L. H. and Ni, P. and Bond, T. L. and Sinclair, S. J. and Jette, A. M.}
}
@article {87,
	title = {Refining the conceptual basis for rehabilitation outcome measurement: personal care and instrumental activities domain},
	journal = {Medical Care},
	volume = {42},
	number = {1 Suppl},
	year = {2004},
	note = {0025-7079Journal Article},
	month = {Jan},
	pages = {I62-172},
	abstract = {BACKGROUND: Rehabilitation outcome measures routinely include content on performance of daily activities; however, the conceptual basis for item selection is rarely specified. These instruments differ significantly in format, number, and specificity of daily activity items and in the measurement dimensions and type of scale used to specify levels of performance. We propose that a requirement for upper limb and hand skills underlies many activities of daily living (ADL) and instrumental activities of daily living (IADL) items in current instruments, and that items selected based on this definition can be placed along a single functional continuum. OBJECTIVE: To examine the dimensional structure and content coverage of a Personal Care and Instrumental Activities item set and to examine the comparability of items from existing instruments and a set of new items as measures of this domain. METHODS: Participants (N = 477) from 3 different disability groups and 4 settings representing the continuum of postacute rehabilitation care were administered the newly developed Activity Measure for Post-Acute Care (AM-PAC), the SF-8, and an additional setting-specific measure: FIM (in-patient rehabilitation); MDS (skilled nursing facility); MDS-PAC (postacute settings); OASIS (home care); or PF-10 (outpatient clinic). Rasch (partial-credit model) analyses were conducted on a set of 62 items covering the Personal Care and Instrumental domain to examine item fit, item functioning, and category difficulty estimates and unidimensionality. RESULTS: After removing 6 misfitting items, the remaining 56 items fit acceptably along the hypothesized continuum. Analyses yielded different difficulty estimates for the maximum score (eg, "Independent performance") for items with comparable content from different instruments. Items showed little differential item functioning across age, diagnosis, or severity groups, and 92\% of the participants fit the model. CONCLUSIONS: ADL and IADL items from existing rehabilitation outcomes instruments that depend on skilled upper limb and hand use can be located along a single continuum, along with the new personal care and instrumental items of the AM-PAC addressing gaps in content. Results support the validity of the proposed definition of the Personal Care and Instrumental Activities dimension of function as a guide for future development of rehabilitation outcome instruments, such as linked, setting-specific short forms and computerized adaptive testing approaches.},
	keywords = {*Self Efficacy, *Sickness Impact Profile, Activities of Daily Living/*classification/psychology, Adult, Aged, Aged, 80 and over, Disability Evaluation, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Outcome Assessment (Health Care)/*methods/statistics \& numerical data, Questionnaires/*standards, Recovery of Function/physiology, Rehabilitation/*standards/statistics \& numerical data, Reproducibility of Results, Research Support, U.S. Gov{\textquoteright}t, Non-P.H.S., Research Support, U.S. Gov{\textquoteright}t, P.H.S., Sensitivity and Specificity},
	author = {Coster, W. J. and Haley, S. M. and Andres, P. L. and Ludlow, L. H. and Bond, T. L. and Ni, P. S.}
}
