@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 {357, title = {Measuring physical function in patients with complex medical and postsurgical conditions: a computer adaptive approach}, journal = {American Journal of Physical Medicine and Rehabilitation}, volume = {84}, number = {10}, year = {2005}, note = {0894-9115 (Print)Comparative StudyJournal ArticleResearch Support, N.I.H., ExtramuralResearch Support, U.S. Gov{\textquoteright}t, P.H.S.}, month = {Oct}, pages = {741-8}, abstract = {OBJECTIVE: To examine whether the range of disability in the medically complex and postsurgical populations receiving rehabilitation is adequately sampled by the new Activity Measure--Post-Acute Care (AM-PAC), and to assess whether computer adaptive testing (CAT) can derive valid patient scores using fewer questions. DESIGN: Observational study of 158 subjects (mean age 67.2 yrs) receiving skilled rehabilitation services in inpatient (acute rehabilitation hospitals, skilled nursing facility units) and community (home health services, outpatient departments) settings for recent-onset or worsening disability from medical (excluding neurological) and surgical (excluding orthopedic) conditions. Measures were interviewer-administered activity questions (all patients) and physical functioning portion of the SF-36 (outpatients) and standardized chart items (11 Functional Independence Measure (FIM), 19 Standardized Outcome and Assessment Information Set (OASIS) items, and 22 Minimum Data Set (MDS) items). Rasch modeling analyzed all data and the relationship between person ability estimates and average item difficulty. CAT assessed the ability to derive accurate patient scores using a sample of questions. RESULTS: The 163-item activity item pool covered the range of physical movement and personal and instrumental activities. CAT analysis showed comparable scores between estimates using 10 items or the total item pool. CONCLUSION: The AM-PAC can assess a broad range of function in patients with complex medical illness. CAT achieves valid patient scores using fewer questions.}, keywords = {Activities of Daily Living/*classification, Adult, Aged, Cohort Studies, Continuity of Patient Care, Disability Evaluation, Female, Health Services Research, Humans, Male, Middle Aged, Postoperative Care/*rehabilitation, Prognosis, Recovery of Function, Rehabilitation Centers, Rehabilitation/*standards, Sensitivity and Specificity, Sickness Impact Profile, Treatment Outcome}, author = {Siebens, H. and Andres, P. L. and Pengsheng, N. and Coster, W. J. and Haley, S. M.} }