TY - JOUR T1 - Replenishing a computerized adaptive test of patient-reported daily activity functioning JF - Quality of Life Research Y1 - 2009 A1 - Haley, S. M. A1 - Ni, P. A1 - Jette, A. M. A1 - Tao, W. A1 - Moed, R. A1 - Meyers, D. A1 - Ludlow, L. H. KW - *Activities of Daily Living KW - *Disability Evaluation KW - *Questionnaires KW - *User-Computer Interface KW - Adult KW - Aged KW - Cohort Studies KW - Computer-Assisted Instruction KW - Female KW - Humans KW - Male KW - Middle Aged KW - Outcome Assessment (Health Care)/*methods AB - PURPOSE: Computerized adaptive testing (CAT) item banks may need to be updated, but before new items can be added, they must be linked to the previous CAT. The purpose of this study was to evaluate 41 pretest items prior to including them into an operational CAT. METHODS: We recruited 6,882 patients with spine, lower extremity, upper extremity, and nonorthopedic impairments who received outpatient rehabilitation in one of 147 clinics across 13 states of the USA. Forty-one new Daily Activity (DA) items were administered along with the Activity Measure for Post-Acute Care Daily Activity CAT (DA-CAT-1) in five separate waves. We compared the scoring consistency with the full item bank, test information function (TIF), person standard errors (SEs), and content range of the DA-CAT-1 to the new CAT (DA-CAT-2) with the pretest items by real data simulations. RESULTS: We retained 29 of the 41 pretest items. Scores from the DA-CAT-2 were more consistent (ICC = 0.90 versus 0.96) than DA-CAT-1 when compared with the full item bank. TIF and person SEs were improved for persons with higher levels of DA functioning, and ceiling effects were reduced from 16.1% to 6.1%. CONCLUSIONS: Item response theory and online calibration methods were valuable in improving the DA-CAT. VL - 18 SN - 0962-9343 (Print)0962-9343 (Linking) N1 - Haley, Stephen MNi, PengshengJette, Alan MTao, WeiMoed, RichardMeyers, DougLudlow, Larry HK02 HD45354-01/HD/NICHD NIH HHS/United StatesResearch Support, N.I.H., ExtramuralNetherlandsQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitationQual Life Res. 2009 May;18(4):461-71. Epub 2009 Mar 14. ER - TY - JOUR T1 - Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: II. Participation outcomes JF - Archives of Physical Medicine and Rehabilitation Y1 - 2008 A1 - Haley, S. M. A1 - Gandek, B. A1 - Siebens, H. A1 - Black-Schaffer, R. M. A1 - Sinclair, S. J. A1 - Tao, W. A1 - Coster, W. J. A1 - Ni, P. A1 - Jette, A. M. KW - *Activities of Daily Living KW - *Adaptation, Physiological KW - *Computer Systems KW - *Questionnaires KW - Adult KW - Aged KW - Aged, 80 and over KW - Chi-Square Distribution KW - Factor Analysis, Statistical KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Outcome Assessment (Health Care)/*methods KW - Patient Discharge KW - Prospective Studies KW - Rehabilitation/*standards KW - Subacute Care/*standards AB - OBJECTIVES: To measure participation outcomes with a computerized adaptive test (CAT) and compare CAT and traditional fixed-length surveys in terms of score agreement, respondent burden, discriminant validity, and responsiveness. DESIGN: Longitudinal, prospective cohort study of patients interviewed approximately 2 weeks after discharge from inpatient rehabilitation and 3 months later. SETTING: Follow-up interviews conducted in patient's home setting. PARTICIPANTS: Adults (N=94) with diagnoses of neurologic, orthopedic, or medically complex conditions. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participation domains of mobility, domestic life, and community, social, & civic life, measured using a CAT version of the Participation Measure for Postacute Care (PM-PAC-CAT) and a 53-item fixed-length survey (PM-PAC-53). RESULTS: The PM-PAC-CAT showed substantial agreement with PM-PAC-53 scores (intraclass correlation coefficient, model 3,1, .71-.81). On average, the PM-PAC-CAT was completed in 42% of the time and with only 48% of the items as compared with the PM-PAC-53. Both formats discriminated across functional severity groups. The PM-PAC-CAT had modest reductions in sensitivity and responsiveness to patient-reported change over a 3-month interval as compared with the PM-PAC-53. CONCLUSIONS: Although continued evaluation is warranted, accurate estimates of participation status and responsiveness to change for group-level analyses can be obtained from CAT administrations, with a sizeable reduction in respondent burden. VL - 89 SN - 1532-821X (Electronic)0003-9993 (Linking) N1 - Haley, Stephen MGandek, BarbaraSiebens, HilaryBlack-Schaffer, Randie MSinclair, Samuel JTao, WeiCoster, Wendy JNi, PengshengJette, Alan MK02 HD045354-01A1/HD/NICHD NIH HHS/United StatesK02 HD45354-01/HD/NICHD NIH HHS/United StatesR01 HD043568/HD/NICHD NIH HHS/United StatesR01 HD043568-01/HD/NICHD NIH HHS/United StatesResearch Support, N.I.H., ExtramuralUnited StatesArchives of physical medicine and rehabilitationArch Phys Med Rehabil. 2008 Feb;89(2):275-83. U2 - 2666330 ER - TY - JOUR T1 - Computer adaptive testing improved accuracy and precision of scores over random item selection in a physical functioning item bank JF - Journal of Clinical Epidemiology Y1 - 2006 A1 - Haley, S. M. A1 - Ni, P. A1 - Hambleton, R. K. A1 - Slavin, M. D. A1 - Jette, A. M. KW - *Recovery of Function KW - Activities of Daily Living KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Confidence Intervals KW - Factor Analysis, Statistical KW - Female KW - Humans KW - Male KW - Middle Aged KW - Outcome Assessment (Health Care)/*methods KW - Rehabilitation/*standards KW - Reproducibility of Results KW - Software AB - 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. VL - 59 SN - 0895-4356 (Print) N1 - 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't, Non-P.H.S.EnglandJournal of clinical epidemiologyJ Clin Epidemiol. 2006 Nov;59(11):1174-82. Epub 2006 Jul 11. ER - TY - JOUR T1 - Contemporary measurement techniques for rehabilitation outcomes assessment JF - Journal of Rehabilitation Medicine Y1 - 2005 A1 - Jette, A. M. A1 - Haley, S. M. KW - *Disability Evaluation KW - Activities of Daily Living/classification KW - Disabled Persons/classification/*rehabilitation KW - Health Status Indicators KW - Humans KW - Outcome Assessment (Health Care)/*methods/standards KW - Recovery of Function KW - Research Support, N.I.H., Extramural KW - Research Support, U.S. Gov't, Non-P.H.S. KW - Sensitivity and Specificity computerized adaptive testing AB - In this article, we review the limitations of traditional rehabilitation functional outcome instruments currently in use within the rehabilitation field to assess Activity and Participation domains as defined by the International Classification of Function, Disability, and Health. These include a narrow scope of functional outcomes, data incompatibility across instruments, and the precision vs feasibility dilemma. Following this, we illustrate how contemporary measurement techniques, such as item response theory methods combined with computer adaptive testing methodology, can be applied in rehabilitation to design functional outcome instruments that are comprehensive in scope, accurate, allow for compatibility across instruments, and are sensitive to clinically important change without sacrificing their feasibility. Finally, we present some of the pressing challenges that need to be overcome to provide effective dissemination and training assistance to ensure that current and future generations of rehabilitation professionals are familiar with and skilled in the application of contemporary outcomes measurement. VL - 37 N1 - 1650-1977 (Print)Journal ArticleReview 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 -