%0 Journal Article %J Spine %D 2008 %T Computerized adaptive testing in back pain: Validation of the CAT-5D-QOL %A Kopec, J. A. %A Badii, M. %A McKenna, M. %A Lima, V. D. %A Sayre, E. C. %A Dvorak, M. %K *Disability Evaluation %K *Health Status Indicators %K *Quality of Life %K Adult %K Aged %K Algorithms %K Back Pain/*diagnosis/psychology %K British Columbia %K Diagnosis, Computer-Assisted/*standards %K Feasibility Studies %K Female %K Humans %K Internet %K Male %K Middle Aged %K Predictive Value of Tests %K Questionnaires/*standards %K Reproducibility of Results %X STUDY DESIGN: We have conducted an outcome instrument validation study. OBJECTIVE: Our objective was to develop a computerized adaptive test (CAT) to measure 5 domains of health-related quality of life (HRQL) and assess its feasibility, reliability, validity, and efficiency. SUMMARY OF BACKGROUND DATA: Kopec and colleagues have recently developed item response theory based item banks for 5 domains of HRQL relevant to back pain and suitable for CAT applications. The domains are Daily Activities (DAILY), Walking (WALK), Handling Objects (HAND), Pain or Discomfort (PAIN), and Feelings (FEEL). METHODS: An adaptive algorithm was implemented in a web-based questionnaire administration system. The questionnaire included CAT-5D-QOL (5 scales), Modified Oswestry Disability Index (MODI), Roland-Morris Disability Questionnaire (RMDQ), SF-36 Health Survey, and standard clinical and demographic information. Participants were outpatients treated for mechanical back pain at a referral center in Vancouver, Canada. RESULTS: A total of 215 patients completed the questionnaire and 84 completed a retest. On average, patients answered 5.2 items per CAT-5D-QOL scale. Reliability ranged from 0.83 (FEEL) to 0.92 (PAIN) and was 0.92 for the MODI, RMDQ, and Physical Component Summary (PCS-36). The ceiling effect was 0.5% for PAIN compared with 2% for MODI and 5% for RMQ. The CAT-5D-QOL scales correlated as anticipated with other measures of HRQL and discriminated well according to the level of satisfaction with current symptoms, duration of the last episode, sciatica, and disability compensation. The average relative discrimination index was 0.87 for PAIN, 0.67 for DAILY and 0.62 for WALK, compared with 0.89 for MODI, 0.80 for RMDQ, and 0.59 for PCS-36. CONCLUSION: The CAT-5D-QOL is feasible, reliable, valid, and efficient in patients with back pain. This methodology can be recommended for use in back pain research and should improve outcome assessment, facilitate comparisons across studies, and reduce patient burden. %B Spine %7 2008/05/23 %V 33 %P 1384-90 %8 May 20 %@ 1528-1159 (Electronic)0362-2436 (Linking) %G eng %M 18496353 %0 Journal Article %J Quality of Life Research %D 2007 %T Developing tailored instruments: item banking and computerized adaptive assessment %A Bjorner, J. B. %A Chang, C-H. %A Thissen, D. %A Reeve, B. B. %K *Health Status %K *Health Status Indicators %K *Mental Health %K *Outcome Assessment (Health Care) %K *Quality of Life %K *Questionnaires %K *Software %K Algorithms %K Factor Analysis, Statistical %K Humans %K Models, Statistical %K Psychometrics %X Item banks and Computerized Adaptive Testing (CAT) have the potential to greatly improve the assessment of health outcomes. This review describes the unique features of item banks and CAT and discusses how to develop item banks. In CAT, a computer selects the items from an item bank that are most relevant for and informative about the particular respondent; thus optimizing test relevance and precision. Item response theory (IRT) provides the foundation for selecting the items that are most informative for the particular respondent and for scoring responses on a common metric. The development of an item bank is a multi-stage process that requires a clear definition of the construct to be measured, good items, a careful psychometric analysis of the items, and a clear specification of the final CAT. The psychometric analysis needs to evaluate the assumptions of the IRT model such as unidimensionality and local independence; that the items function the same way in different subgroups of the population; and that there is an adequate fit between the data and the chosen item response models. Also, interpretation guidelines need to be established to help the clinical application of the assessment. Although medical research can draw upon expertise from educational testing in the development of item banks and CAT, the medical field also encounters unique opportunities and challenges. %B Quality of Life Research %7 2007/05/29 %V 16 %P 95-108 %@ 0962-9343 (Print) %G eng %M 17530450 %0 Journal Article %J Quality of Life Research %D 2007 %T IRT health outcomes data analysis project: an overview and summary %A Cook, K. F. %A Teal, C. R. %A Bjorner, J. B. %A Cella, D. %A Chang, C-H. %A Crane, P. K. %A Gibbons, L. E. %A Hays, R. D. %A McHorney, C. A. %A Ocepek-Welikson, K. %A Raczek, A. E. %A Teresi, J. A. %A Reeve, B. B. %K *Data Interpretation, Statistical %K *Health Status %K *Quality of Life %K *Questionnaires %K *Software %K Female %K HIV Infections/psychology %K Humans %K Male %K Neoplasms/psychology %K Outcome Assessment (Health Care)/*methods %K Psychometrics %K Stress, Psychological %X BACKGROUND: In June 2004, the National Cancer Institute and the Drug Information Association co-sponsored the conference, "Improving the Measurement of Health Outcomes through the Applications of Item Response Theory (IRT) Modeling: Exploration of Item Banks and Computer-Adaptive Assessment." A component of the conference was presentation of a psychometric and content analysis of a secondary dataset. OBJECTIVES: A thorough psychometric and content analysis was conducted of two primary domains within a cancer health-related quality of life (HRQOL) dataset. RESEARCH DESIGN: HRQOL scales were evaluated using factor analysis for categorical data, IRT modeling, and differential item functioning analyses. In addition, computerized adaptive administration of HRQOL item banks was simulated, and various IRT models were applied and compared. SUBJECTS: The original data were collected as part of the NCI-funded Quality of Life Evaluation in Oncology (Q-Score) Project. A total of 1,714 patients with cancer or HIV/AIDS were recruited from 5 clinical sites. MEASURES: Items from 4 HRQOL instruments were evaluated: Cancer Rehabilitation Evaluation System-Short Form, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Functional Assessment of Cancer Therapy and Medical Outcomes Study Short-Form Health Survey. RESULTS AND CONCLUSIONS: Four lessons learned from the project are discussed: the importance of good developmental item banks, the ambiguity of model fit results, the limits of our knowledge regarding the practical implications of model misfit, and the importance in the measurement of HRQOL of construct definition. With respect to these lessons, areas for future research are suggested. The feasibility of developing item banks for broad definitions of health is discussed. %B Quality of Life Research %7 2007/03/14 %V 16 %P 121-132 %@ 0962-9343 (Print) %G eng %M 17351824 %0 Journal Article %J Quality of Life Research %D 2007 %T Patient-reported outcomes measurement and management with innovative methodologies and technologies %A Chang, C-H. %K *Health Status %K *Outcome Assessment (Health Care) %K *Quality of Life %K *Software %K Computer Systems/*trends %K Health Insurance Portability and Accountability Act %K Humans %K Patient Satisfaction %K Questionnaires %K United States %X Successful integration of modern psychometrics and advanced informatics in patient-reported outcomes (PRO) measurement and management can potentially maximize the value of health outcomes research and optimize the delivery of quality patient care. Unlike the traditional labor-intensive paper-and-pencil data collection method, item response theory-based computerized adaptive testing methodologies coupled with novel technologies provide an integrated environment to collect, analyze and present ready-to-use PRO data for informed and shared decision-making. This article describes the needs, challenges and solutions for accurate, efficient and cost-effective PRO data acquisition and dissemination means in order to provide critical and timely PRO information necessary to actively support and enhance routine patient care in busy clinical settings. %B Quality of Life Research %7 2007/05/29 %V 16 Suppl 1 %P 157-66 %@ 0962-9343 (Print)0962-9343 (Linking) %G eng %M 17530448 %0 Journal Article %J Medical Care %D 2007 %T Psychometric evaluation and calibration of health-related quality of life item banks: plans for the Patient-Reported Outcomes Measurement Information System (PROMIS) %A Reeve, B. B. %A Hays, R. D. %A Bjorner, J. B. %A Cook, K. F. %A Crane, P. K. %A Teresi, J. A. %A Thissen, D. %A Revicki, D. A. %A Weiss, D. J. %A Hambleton, R. K. %A Liu, H. %A Gershon, R. C. %A Reise, S. P. %A Lai, J. S. %A Cella, D. %K *Health Status %K *Information Systems %K *Quality of Life %K *Self Disclosure %K Adolescent %K Adult %K Aged %K Calibration %K Databases as Topic %K Evaluation Studies as Topic %K Female %K Humans %K Male %K Middle Aged %K Outcome Assessment (Health Care)/*methods %K Psychometrics %K Questionnaires/standards %K United States %X BACKGROUND: The construction and evaluation of item banks to measure unidimensional constructs of health-related quality of life (HRQOL) is a fundamental objective of the Patient-Reported Outcomes Measurement Information System (PROMIS) project. OBJECTIVES: Item banks will be used as the foundation for developing short-form instruments and enabling computerized adaptive testing. The PROMIS Steering Committee selected 5 HRQOL domains for initial focus: physical functioning, fatigue, pain, emotional distress, and social role participation. This report provides an overview of the methods used in the PROMIS item analyses and proposed calibration of item banks. ANALYSES: Analyses include evaluation of data quality (eg, logic and range checking, spread of response distribution within an item), descriptive statistics (eg, frequencies, means), item response theory model assumptions (unidimensionality, local independence, monotonicity), model fit, differential item functioning, and item calibration for banking. RECOMMENDATIONS: Summarized are key analytic issues; recommendations are provided for future evaluations of item banks in HRQOL assessment. %B Medical Care %7 2007/04/20 %V 45 %P S22-31 %8 May %@ 0025-7079 (Print) %G eng %M 17443115 %0 Journal Article %J Quality of Life Research %D 2006 %T Computerized adaptive testing of diabetes impact: a feasibility study of Hispanics and non-Hispanics in an active clinic population %A Schwartz, C. %A Welch, G. %A Santiago-Kelley, P. %A Bode, R. %A Sun, X. %K *Computers %K *Hispanic Americans %K *Quality of Life %K Adult %K Aged %K Data Collection/*methods %K Diabetes Mellitus/*psychology %K Feasibility Studies %K Female %K Humans %K Language %K Male %K Middle Aged %X BACKGROUND: Diabetes is a leading cause of death and disability in the US and is twice as common among Hispanic Americans as non-Hispanics. The societal costs of diabetes provide an impetus for developing tools that can improve patient care and delay or prevent diabetes complications. METHODS: We implemented a feasibility study of a Computerized Adaptive Test (CAT) to measure diabetes impact using a sample of 103 English- and 97 Spanish-speaking patients (mean age = 56.5, 66.5% female) in a community medical center with a high proportion of minority patients (28% African-American). The 37 items of the Diabetes Impact Survey were translated using forward-backward translation and cognitive debriefing. Participants were randomized to receive either the full-length tool or the Diabetes-CAT first, in the patient's native language. RESULTS: The number of items and the amount of time to complete the survey for the CAT was reduced to one-sixth the amount for the full-length tool in both languages, across disease severity. Confirmatory Factor Analysis confirmed that the Diabetes Impact Survey is unidimensional. The Diabetes-CAT demonstrated acceptable internal consistency reliability, construct validity, and discriminant validity in the overall sample, although subgroup analyses suggested that the English sample data evidenced higher levels of reliability and validity than the Spanish sample and issues with discriminant validity in the Spanish sample. Differential Item Function analysis revealed differences in responses tendencies by language group in 3 of the 37 items. Participant interviews suggested that the Spanish-speaking patients generally preferred the paper survey to the computer-assisted tool, and were twice as likely to experience difficulties understanding the items. CONCLUSIONS: While the Diabetes-CAT demonstrated clear advantages in reducing respondent burden as compared to the full-length tool, simplifying the item bank will be necessary for enhancing the feasibility of the Diabetes-CAT for use with low literacy patients. %B Quality of Life Research %7 2006/10/13 %V 15 %P 1503-18 %8 Nov %@ 0962-9343 (Print) %G eng %M 17031500 %0 Journal Article %J Quality of Life Research %D 2006 %T Factor analysis techniques for assessing sufficient unidimensionality of cancer related fatigue %A Lai, J-S. %A Crane, P. K. %A Cella, D. %K *Factor Analysis, Statistical %K *Quality of Life %K Aged %K Chicago %K Fatigue/*etiology %K Female %K Humans %K Male %K Middle Aged %K Neoplasms/*complications %K Questionnaires %X BACKGROUND: Fatigue is the most common unrelieved symptom experienced by people with cancer. The purpose of this study was to examine whether cancer-related fatigue (CRF) can be summarized using a single score, that is, whether CRF is sufficiently unidimensional for measurement approaches that require or assume unidimensionality. We evaluated this question using factor analysis techniques including the theory-driven bi-factor model. METHODS: Five hundred and fifty five cancer patients from the Chicago metropolitan area completed a 72-item fatigue item bank, covering a range of fatigue-related concerns including intensity, frequency and interference with physical, mental, and social activities. Dimensionality was assessed using exploratory and confirmatory factor analysis (CFA) techniques. RESULTS: Exploratory factor analysis (EFA) techniques identified from 1 to 17 factors. The bi-factor model suggested that CRF was sufficiently unidimensional. CONCLUSIONS: CRF can be considered sufficiently unidimensional for applications that require unidimensionality. One such application, item response theory (IRT), will facilitate the development of short-form and computer-adaptive testing. This may further enable practical and accurate clinical assessment of CRF. %B Quality of Life Research %V 15 %P 1179-90 %8 Sep %G eng %M 17001438 %0 Journal Article %J Quality of Life Research %D 2006 %T Multidimensional computerized adaptive testing of the EORTC QLQ-C30: basic developments and evaluations %A Petersen, M. A. %A Groenvold, M. %A Aaronson, N. K. %A Fayers, P. %A Sprangers, M. %A Bjorner, J. B. %K *Quality of Life %K *Self Disclosure %K Adult %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Questionnaires/*standards %K User-Computer Interface %X OBJECTIVE: Self-report questionnaires are widely used to measure health-related quality of life (HRQOL). Ideally, such questionnaires should be adapted to the individual patient and at the same time scores should be directly comparable across patients. This may be achieved using computerized adaptive testing (CAT). Usually, CAT is carried out for a single domain at a time. However, many HRQOL domains are highly correlated. Multidimensional CAT may utilize these correlations to improve measurement efficiency. We investigated the possible advantages and difficulties of multidimensional CAT. STUDY DESIGN AND SETTING: We evaluated multidimensional CAT of three scales from the EORTC QLQ-C30: the physical functioning, emotional functioning, and fatigue scales. Analyses utilised a database with 2958 European cancer patients. RESULTS: It was possible to obtain scores for the three domains with five to seven items administered using multidimensional CAT that were very close to the scores obtained using all 12 items and with no or little loss of measurement precision. CONCLUSION: The findings suggest that multidimensional CAT may significantly improve measurement precision and efficiency and encourage further research into multidimensional CAT. Particularly, the estimation of the model underlying the multidimensional CAT and the conceptual aspects need further investigations. %B Quality of Life Research %7 2006/03/21 %V 15 %P 315-29 %8 Apr %@ 0962-9343 (Print) %G eng %M 16547770 %0 Journal Article %J Evaluation and the Health Professions %D 2005 %T Data pooling and analysis to build a preliminary item bank: an example using bowel function in prostate cancer %A Eton, D. T. %A Lai, J. S. %A Cella, D. %A Reeve, B. B. %A Talcott, J. A. %A Clark, J. A. %A McPherson, C. P. %A Litwin, M. S. %A Moinpour, C. M. %K *Quality of Life %K *Questionnaires %K Adult %K Aged %K Data Collection/methods %K Humans %K Intestine, Large/*physiopathology %K Male %K Middle Aged %K Prostatic Neoplasms/*physiopathology %K Psychometrics %K Research Support, Non-U.S. Gov't %K Statistics, Nonparametric %X Assessing bowel function (BF) in prostate cancer can help determine therapeutic trade-offs. We determined the components of BF commonly assessed in prostate cancer studies as an initial step in creating an item bank for clinical and research application. We analyzed six archived data sets representing 4,246 men with prostate cancer. Thirty-one items from validated instruments were available for analysis. Items were classified into domains (diarrhea, rectal urgency, pain, bleeding, bother/distress, and other) then subjected to conventional psychometric and item response theory (IRT) analyses. Items fit the IRT model if the ratio between observed and expected item variance was between 0.60 and 1.40. Four of 31 items had inadequate fit in at least one analysis. Poorly fitting items included bleeding (2), rectal urgency (1), and bother/distress (1). A fifth item assessing hemorrhoids was poorly correlated with other items. Our analyses supported four related components of BF: diarrhea, rectal urgency, pain, and bother/distress. %B Evaluation and the Health Professions %V 28 %P 142-59 %G eng %M 15851770 %0 Journal Article %J Seminars in Oncology %D 2002 %T Advances in quality of life measurements in oncology patients %A Cella, D. %A Chang, C-H. %A Lai, J. S. %A Webster, K. %K *Quality of Life %K *Sickness Impact Profile %K Cross-Cultural Comparison %K Culture %K Humans %K Language %K Neoplasms/*physiopathology %K Questionnaires %X Accurate assessment of the quality of life (QOL) of patients can provide important clinical information to physicians, especially in the area of oncology. Changes in QOL are important indicators of the impact of a new cytotoxic therapy, can affect a patient's willingness to continue treatment, and may aid in defining response in the absence of quantifiable endpoints such as tumor regression. Because QOL is becoming an increasingly important aspect in the management of patients with malignant disease, it is vital that the instruments used to measure QOL are reliable and accurate. Assessment of QOL involves a multidimensional approach that includes physical, functional, social, and emotional well-being, and the most comprehensive instruments measure at least three of these domains. Instruments to measure QOL can be generic (eg, the Nottingham Health Profile), targeted toward specific illnesses (eg, Functional Assessment of Cancer Therapy - Lung), or be a combination of generic and targeted. Two of the most widely used examples of the combination, or hybrid, instruments are the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 Items and the Functional Assessment of Chronic Illness Therapy. A consequence of the increasing international collaboration in clinical trials has been the growing necessity for instruments that are valid across languages and cultures. To assure the continuing reliability and validity of QOL instruments in this regard, item response theory can be applied. Techniques such as item response theory may be used in the future to construct QOL item banks containing large sets of validated questions that represent various levels of QOL domains. As QOL becomes increasingly important in understanding and approaching the overall management of cancer patients, the tools available to clinicians and researchers to assess QOL will continue to evolve. While the instruments currently available provide reliable and valid measurement, further improvements in precision and application are anticipated. %B Seminars in Oncology %V 29 %P 60-8 %8 Jun %G eng %M 12082656 %0 Journal Article %J Archives of Physical Medicine and Rehabilitation %D 2002 %T Measuring quality of life in chronic illness: the functional assessment of chronic illness therapy measurement system %A Cella, D. %A Nowinski, C. J. %K *Chronic Disease %K *Quality of Life %K *Rehabilitation %K Adult %K Comparative Study %K Health Status Indicators %K Humans %K Psychometrics %K Questionnaires %K Research Support, U.S. Gov't, P.H.S. %K Sensitivity and Specificity %X We focus on quality of life (QOL) measurement as applied to chronic illness. There are 2 major types of health-related quality of life (HRQOL) instruments-generic health status and targeted. Generic instruments offer the opportunity to compare results across patient and population cohorts, and some can provide normative or benchmark data from which to interpret results. Targeted instruments ask questions that focus more on the specific condition or treatment under study and, as a result, tend to be more responsive to clinically important changes than generic instruments. Each type of instrument has a place in the assessment of HRQOL in chronic illness, and consideration of the relative advantages and disadvantages of the 2 options best drives choice of instrument. The Functional Assessment of Chronic Illness Therapy (FACIT) system of HRQOL measurement is a hybrid of the 2 approaches. The FACIT system combines a core general measure with supplemental measures targeted toward specific diseases, conditions, or treatments. Thus, it capitalizes on the strengths of each type of measure. Recently, FACIT questionnaires were administered to a representative sample of the general population with results used to derive FACIT norms. These normative data can be used for benchmarking and to better understand changes in HRQOL that are often seen in clinical trials. Future directions in HRQOL assessment include test equating, item banking, and computerized adaptive testing. %B Archives of Physical Medicine and Rehabilitation %V 83 %P S10-7 %8 Dec %G eng %M 12474167 %0 Journal Article %J Quality of Life Research %D 1997 %T Health status assessment for the twenty-first century: item response theory, item banking and computer adaptive testing %A Revicki, D. A. %A Cella, D. F. %K *Health Status %K *HIV Infections/diagnosis %K *Quality of Life %K Diagnosis, Computer-Assisted %K Disease Progression %K Humans %K Psychometrics/*methods %X Health status assessment is frequently used to evaluate the combined impact of human immunodeficiency virus (HIV) disease and its treatment on functioning and well-being from the patient's perspective. No single health status measure can efficiently cover the range of problems in functioning and well-being experienced across HIV disease stages. Item response theory (IRT), item banking and computer adaptive testing (CAT) provide a solution to measuring health-related quality of life (HRQoL) across different stages of HIV disease. IRT allows us to examine the response characteristics of individual items and the relationship between responses to individual items and the responses to each other item in a domain. With information on the response characteristics of a large number of items covering a HRQoL domain (e.g. physical function, and psychological well-being), and information on the interrelationships between all pairs of these items and the total scale, we can construct more efficient scales. Item banks consist of large sets of questions representing various levels of a HRQoL domain that can be used to develop brief, efficient scales for measuring the domain. CAT is the application of IRT and item banks to the tailored assessment of HRQoL domains specific to individual patients. Given the results of IRT analyses and computer-assisted test administration, more efficient and brief scales can be used to measure multiple domains of HRQoL for clinical trials and longitudinal observational studies. %B Quality of Life Research %7 1997/08/01 %V 6 %P 595-600 %8 Aug %@ 0962-9343 (Print) %G eng %M 9330558