TY - JOUR T1 - Computerized adaptive testing for patients with knee inpairments produced valid and responsive measures of function JF - Journal of Clinical Epidemiology Y1 - 2008 A1 - Hart, D. L. A1 - Wang, Y-C. A1 - Stratford, P. W. A1 - Mioduski, J. E. VL - 61 ER - TY - JOUR T1 - Simulated computerized adaptive test for patients with lumbar spine impairments was efficient and produced valid measures of function JF - Journal of Clinical Epidemiology Y1 - 2006 A1 - Hart, D. L. A1 - Mioduski, J. E. A1 - Werneke, M. W. A1 - Stratford, P. W. KW - Back Pain Functional Scale KW - computerized adaptive testing KW - Item Response Theory KW - Lumbar spine KW - Rehabilitation KW - True-score equating AB - Objective: To equate physical functioning (PF) items with Back Pain Functional Scale (BPFS) items, develop a computerized adaptive test (CAT) designed to assess lumbar spine functional status (LFS) in people with lumbar spine impairments, and compare discriminant validity of LFS measures (qIRT) generated using all items analyzed with a rating scale Item Response Theory model (RSM) and measures generated using the simulated CAT (qCAT). Methods: We performed a secondary analysis of retrospective intake rehabilitation data. Results: Unidimensionality and local independence of 25 BPFS and PF items were supported. Differential item functioning was negligible for levels of symptom acuity, gender, age, and surgical history. The RSM fit the data well. A lumbar spine specific CAT was developed that was 72% more efficient than using all 25 items to estimate LFS measures. qIRT and qCAT measures did not discriminate patients by symptom acuity, age, or gender, but discriminated patients by surgical history in similar clinically logical ways. qCAT measures were as precise as qIRT measures. Conclusion: A body part specific simulated CAT developed from an LFS item bank was efficient and produced precise measures of LFS without eroding discriminant validity. VL - 59 ER - TY - JOUR T1 - Simulated computerized adaptive test for patients with shoulder impairments was efficient and produced valid measures of function JF - Journal of Clinical Epidemiology Y1 - 2006 A1 - Hart, D. L. A1 - Cook, K. F. A1 - Mioduski, J. E. A1 - Teal, C. R. A1 - Crane, P. K. KW - *Computer Simulation KW - *Range of Motion, Articular KW - Activities of Daily Living KW - Adult KW - Aged KW - Aged, 80 and over KW - Factor Analysis, Statistical KW - Female KW - Humans KW - Male KW - Middle Aged KW - Prospective Studies KW - Reproducibility of Results KW - Research Support, N.I.H., Extramural KW - Research Support, U.S. Gov't, Non-P.H.S. KW - Shoulder Dislocation/*physiopathology/psychology/rehabilitation KW - Shoulder Pain/*physiopathology/psychology/rehabilitation KW - Shoulder/*physiopathology KW - Sickness Impact Profile KW - Treatment Outcome AB - BACKGROUND AND OBJECTIVE: To test unidimensionality and local independence of a set of shoulder functional status (SFS) items, develop a computerized adaptive test (CAT) of the items using a rating scale item response theory model (RSM), and compare discriminant validity of measures generated using all items (theta(IRT)) and measures generated using the simulated CAT (theta(CAT)). STUDY DESIGN AND SETTING: We performed a secondary analysis of data collected prospectively during rehabilitation of 400 patients with shoulder impairments who completed 60 SFS items. RESULTS: Factor analytic techniques supported that the 42 SFS items formed a unidimensional scale and were locally independent. Except for five items, which were deleted, the RSM fit the data well. The remaining 37 SFS items were used to generate the CAT. On average, 6 items were needed to estimate precise measures of function using the SFS CAT, compared with all 37 SFS items. The theta(IRT) and theta(CAT) measures were highly correlated (r = .96) and resulted in similar classifications of patients. CONCLUSION: The simulated SFS CAT was efficient and produced precise, clinically relevant measures of functional status with good discriminating ability. VL - 59 N1 - 0895-4356 (Print)Journal ArticleValidation Studies ER - TY - JOUR T1 - Simulated computerized adaptive test for patients with shoulder impairments was efficient and produced valid measures of function JF - Journal of Clinical Epidemiology Y1 - 2006 A1 - Hart, D. L. A1 - Cook, K. F. A1 - Mioduski, J. E. A1 - Teal, C. R. A1 - Crane, P. K. KW - computerized adaptive testing KW - Flexilevel Scale of Shoulder Function KW - Item Response Theory KW - Rehabilitation AB -

Background and Objective: To test unidimensionality and local independence of a set of shoulder functional status (SFS) items,
develop a computerized adaptive test (CAT) of the items using a rating scale item response theory model (RSM), and compare discriminant validity of measures generated using all items (qIRT) and measures generated using the simulated CAT (qCAT).
Study Design and Setting: We performed a secondary analysis of data collected prospectively during rehabilitation of 400 patients
with shoulder impairments who completed 60 SFS items.
Results: Factor analytic techniques supported that the 42 SFS items formed a unidimensional scale and were locally independent. Except for five items, which were deleted, the RSM fit the data well. The remaining 37 SFS items were used to generate the CAT. On average, 6 items on were needed to estimate precise measures of function using the SFS CAT, compared with all 37 SFS items. The qIRT and qCAT measures were highly correlated (r 5 .96) and resulted in similar classifications of patients.
Conclusion: The simulated SFS CAT was efficient and produced precise, clinically relevant measures of functional status with good
discriminating ability. 

VL - 59 IS - 3 ER - TY - JOUR T1 - Simulated computerized adaptive tests for measuring functional status were efficient with good discriminant validity in patients with hip, knee, or foot/ankle impairments JF - Journal of Clinical Epidemiology Y1 - 2005 A1 - Hart, D. L. A1 - Mioduski, J. E. A1 - Stratford, P. W. KW - *Health Status Indicators KW - Activities of Daily Living KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Ankle Joint/physiopathology KW - Diagnosis, Computer-Assisted/*methods KW - Female KW - Hip Joint/physiopathology KW - Humans KW - Joint Diseases/physiopathology/*rehabilitation KW - Knee Joint/physiopathology KW - Lower Extremity/*physiopathology KW - Male KW - Middle Aged KW - Research Support, N.I.H., Extramural KW - Research Support, U.S. Gov't, P.H.S. KW - Retrospective Studies AB - BACKGROUND AND OBJECTIVE: To develop computerized adaptive tests (CATs) designed to assess lower extremity functional status (FS) in people with lower extremity impairments using items from the Lower Extremity Functional Scale and compare discriminant validity of FS measures generated using all items analyzed with a rating scale Item Response Theory model (theta(IRT)) and measures generated using the simulated CATs (theta(CAT)). METHODS: Secondary analysis of retrospective intake rehabilitation data. RESULTS: Unidimensionality of items was strong, and local independence of items was adequate. Differential item functioning (DIF) affected item calibration related to body part, that is, hip, knee, or foot/ankle, but DIF did not affect item calibration for symptom acuity, gender, age, or surgical history. Therefore, patients were separated into three body part specific groups. The rating scale model fit all three data sets well. Three body part specific CATs were developed: each was 70% more efficient than using all LEFS items to estimate FS measures. theta(IRT) and theta(CAT) measures discriminated patients by symptom acuity, age, and surgical history in similar ways. theta(CAT) measures were as precise as theta(IRT) measures. CONCLUSION: Body part-specific simulated CATs were efficient and produced precise measures of FS with good discriminant validity. VL - 58 N1 - 0895-4356 (Print)Journal ArticleMulticenter StudyValidation Studies ER - TY - JOUR T1 - Development of an index of physical functional health status in rehabilitation JF - Archives of Physical Medicine and Rehabilitation Y1 - 2002 A1 - Hart, D. L. A1 - Wright, B. D. KW - *Health Status Indicators KW - *Rehabilitation Centers KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Female KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Musculoskeletal Diseases/*physiopathology/*rehabilitation KW - Nervous System Diseases/*physiopathology/*rehabilitation KW - Physical Fitness/*physiology KW - Recovery of Function/physiology KW - Reproducibility of Results KW - Retrospective Studies AB - OBJECTIVE: To describe (1) the development of an index of physical functional health status (FHS) and (2) its hierarchical structure, unidimensionality, reproducibility of item calibrations, and practical application. DESIGN: Rasch analysis of existing data sets. SETTING: A total of 715 acute, orthopedic outpatient centers and 62 long-term care facilities in 41 states participating with Focus On Therapeutic Outcomes, Inc. PATIENTS: A convenience sample of 92,343 patients (40% male; mean age +/- standard deviation [SD], 48+/-17y; range, 14-99y) seeking rehabilitation between 1993 and 1999. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patients completed self-report health status surveys at admission and discharge. The Medical Outcomes Study 36-Item Short-Form Health Survey's physical functioning scale (PF-10) is the foundation of the physical FHS. The Oswestry Low Back Pain Disability Questionnaire, Neck Disability Index, Lysholm Knee Questionnaire, items pertinent to patients with upper-extremity impairments, and items pertinent to patients with more involved neuromusculoskeletal impairments were cocalibrated into the PF-10. RESULTS: The final FHS item bank contained 36 items (patient separation, 2.3; root mean square measurement error, 5.9; mean square +/- SD infit, 0.9+/-0.5; outfit, 0.9+/-0.9). Analyses supported empirical item hierarchy, unidimensionality, reproducibility of item calibrations, and content and construct validity of the FHS-36. CONCLUSIONS: Results support the reliability and validity of FHS-36 measures in the present sample. Analyses show the potential for a dynamic, computer-controlled, adaptive survey for FHS assessment applicable for group analysis and clinical decision making for individual patients. VL - 83 N1 - 0003-9993 (Print)Journal Article ER -