TY - JOUR T1 - Efficiency and sensitivity of multidimensional computerized adaptive testing of pediatric physical functioning JF - Disability & Rehabilitation Y1 - 2008 A1 - Allen, D. D. A1 - Ni, P. A1 - Haley, S. M. KW - *Disability Evaluation KW - Child KW - Computers KW - Disabled Children/*classification/rehabilitation KW - Efficiency KW - Humans KW - Outcome Assessment (Health Care) KW - Psychometrics KW - Reproducibility of Results KW - Retrospective Studies KW - Self Care KW - Sensitivity and Specificity AB - 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. VL - 30 SN - 0963-8288 (Print)0963-8288 (Linking) N1 - 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. ER - TY - JOUR T1 - Measurement precision and efficiency of multidimensional computer adaptive testing of physical functioning using the pediatric evaluation of disability inventory JF - Archives of Physical Medicine and Rehabilitation Y1 - 2006 A1 - Haley, S. M. A1 - Ni, P. A1 - Ludlow, L. H. A1 - Fragala-Pinkham, M. A. KW - *Disability Evaluation KW - *Pediatrics KW - Adolescent KW - Child KW - Child, Preschool KW - Computers KW - Disabled Persons/*classification/rehabilitation KW - Efficiency KW - Humans KW - Infant KW - Outcome Assessment (Health Care) KW - Psychometrics KW - Self Care AB - OBJECTIVE: To compare the measurement efficiency and precision of a multidimensional computer adaptive testing (M-CAT) application to a unidimensional CAT (U-CAT) comparison using item bank data from 2 of the functional skills scales of the Pediatric Evaluation of Disability Inventory (PEDI). DESIGN: Using existing PEDI mobility and self-care item banks, we compared the stability of item calibrations and model fit between unidimensional and multidimensional Rasch models and compared the efficiency and precision of the U-CAT- and M-CAT-simulated assessments to a random draw of items. SETTING: Pediatric rehabilitation hospital and clinics. PARTICIPANTS: Clinical and normative samples. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: The M-CAT had greater levels of precision and efficiency than the separate mobility and self-care U-CAT versions when using a similar number of items for each PEDI subdomain. Equivalent estimation of mobility and self-care scores can be achieved with a 25% to 40% item reduction with the M-CAT compared with the U-CAT. CONCLUSIONS: M-CAT applications appear to have both precision and efficiency advantages compared with separate U-CAT assessments when content subdomains have a high correlation. Practitioners may also realize interpretive advantages of reporting test score information for each subdomain when separate clinical inferences are desired. VL - 87 SN - 0003-9993 (Print) N1 - Haley, Stephen MNi, PengshengLudlow, Larry HFragala-Pinkham, Maria AK02 hd45354-01/hd/nichdResearch Support, N.I.H., ExtramuralResearch Support, Non-U.S. Gov'tUnited StatesArchives of physical medicine and rehabilitationArch Phys Med Rehabil. 2006 Sep;87(9):1223-9. ER - TY - JOUR T1 - Activity outcome measurement for postacute care JF - Medical Care Y1 - 2004 A1 - Haley, S. M. A1 - Coster, W. J. A1 - Andres, P. L. A1 - Ludlow, L. H. A1 - Ni, P. A1 - Bond, T. L. A1 - Sinclair, S. J. A1 - Jette, A. M. KW - *Self Efficacy KW - *Sickness Impact Profile KW - Activities of Daily Living/*classification/psychology KW - Adult KW - Aftercare/*standards/statistics & numerical data KW - Aged KW - Boston KW - Cognition/physiology KW - Disability Evaluation KW - Factor Analysis, Statistical KW - Female KW - Human KW - Male KW - Middle Aged KW - Movement/physiology KW - Outcome Assessment (Health Care)/*methods/statistics & numerical data KW - Psychometrics KW - Questionnaires/standards KW - Rehabilitation/*standards/statistics & numerical data KW - Reproducibility of Results KW - Sensitivity and Specificity KW - Support, U.S. Gov't, Non-P.H.S. KW - Support, U.S. Gov't, P.H.S. AB - 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'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. VL - 42 N1 - 0025-7079Journal ArticleMulticenter Study ER -