%0 Journal Article %J Sleep %D 2010 %T Development and validation of patient-reported outcome measures for sleep disturbance and sleep-related impairments %A Buysse, D. J. %A Yu, L. %A Moul, D. E. %A Germain, A. %A Stover, A. %A Dodds, N. E. %A Johnston, K. L. %A Shablesky-Cade, M. A. %A Pilkonis, P. A. %K *Outcome Assessment (Health Care) %K *Self Disclosure %K Adult %K Aged %K Aged, 80 and over %K Cross-Sectional Studies %K Factor Analysis, Statistical %K Female %K Humans %K Male %K Middle Aged %K Psychometrics %K Questionnaires %K Reproducibility of Results %K Sleep Disorders/*diagnosis %K Young Adult %X STUDY OBJECTIVES: To develop an archive of self-report questions assessing sleep disturbance and sleep-related impairments (SRI), to develop item banks from this archive, and to validate and calibrate the item banks using classic validation techniques and item response theory analyses in a sample of clinical and community participants. DESIGN: Cross-sectional self-report study. SETTING: Academic medical center and participant homes. PARTICIPANTS: One thousand nine hundred ninety-three adults recruited from an Internet polling sample and 259 adults recruited from medical, psychiatric, and sleep clinics. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: This study was part of PROMIS (Patient-Reported Outcomes Information System), a National Institutes of Health Roadmap initiative. Self-report item banks were developed through an iterative process of literature searches, collecting and sorting items, expert content review, qualitative patient research, and pilot testing. Internal consistency, convergent validity, and exploratory and confirmatory factor analysis were examined in the resulting item banks. Factor analyses identified 2 preliminary item banks, sleep disturbance and SRI. Item response theory analyses and expert content review narrowed the item banks to 27 and 16 items, respectively. Validity of the item banks was supported by moderate to high correlations with existing scales and by significant differences in sleep disturbance and SRI scores between participants with and without sleep disorders. CONCLUSIONS: The PROMIS sleep disturbance and SRI item banks have excellent measurement properties and may prove to be useful for assessing general aspects of sleep and SRI with various groups of patients and interventions. %B Sleep %7 2010/06/17 %V 33 %P 781-92 %8 Jun 1 %@ 0161-8105 (Print)0161-8105 (Linking) %G eng %M 20550019 %2 2880437 %0 Journal Article %J Rehabilitation Psychology %D 2009 %T Development of an item bank for the assessment of depression in persons with mental illnesses and physical diseases using Rasch analysis %A Forkmann, T. %A Boecker, M. %A Norra, C. %A Eberle, N. %A Kircher, T. %A Schauerte, P. %A Mischke, K. %A Westhofen, M. %A Gauggel, S. %A Wirtz, M. %K Adaptation, Psychological %K Adult %K Aged %K Depressive Disorder/*diagnosis/psychology %K Diagnosis, Computer-Assisted %K Female %K Heart Diseases/*psychology %K Humans %K Male %K Mental Disorders/*psychology %K Middle Aged %K Models, Statistical %K Otorhinolaryngologic Diseases/*psychology %K Personality Assessment/statistics & numerical data %K Personality Inventory/*statistics & numerical data %K Psychometrics/statistics & numerical data %K Questionnaires %K Reproducibility of Results %K Sick Role %X OBJECTIVE: The calibration of item banks provides the basis for computerized adaptive testing that ensures high diagnostic precision and minimizes participants' test burden. The present study aimed at developing a new item bank that allows for assessing depression in persons with mental and persons with somatic diseases. METHOD: The sample consisted of 161 participants treated for a depressive syndrome, and 206 participants with somatic illnesses (103 cardiologic, 103 otorhinolaryngologic; overall mean age = 44.1 years, SD =14.0; 44.7% women) to allow for validation of the item bank in both groups. Persons answered a pool of 182 depression items on a 5-point Likert scale. RESULTS: Evaluation of Rasch model fit (infit < 1.3), differential item functioning, dimensionality, local independence, item spread, item and person separation (>2.0), and reliability (>.80) resulted in a bank of 79 items with good psychometric properties. CONCLUSIONS: The bank provides items with a wide range of content coverage and may serve as a sound basis for computerized adaptive testing applications. It might also be useful for researchers who wish to develop new fixed-length scales for the assessment of depression in specific rehabilitation settings. %B Rehabilitation Psychology %7 2009/05/28 %V 54 %P 186-97 %8 May %@ 0090-5550 (Print)0090-5550 (Linking) %G eng %M 19469609 %0 Journal Article %J Journal of Clinical Epidemiology %D 2009 %T An evaluation of patient-reported outcomes found computerized adaptive testing was efficient in assessing stress perception %A Kocalevent, R. D. %A Rose, M. %A Becker, J. %A Walter, O. B. %A Fliege, H. %A Bjorner, J. B. %A Kleiber, D. %A Klapp, B. F. %K *Diagnosis, Computer-Assisted %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Confidence Intervals %K Female %K Humans %K Male %K Middle Aged %K Perception %K Quality of Health Care/*standards %K Questionnaires %K Reproducibility of Results %K Sickness Impact Profile %K Stress, Psychological/*diagnosis/psychology %K Treatment Outcome %X OBJECTIVES: This study aimed to develop and evaluate a first computerized adaptive test (CAT) for the measurement of stress perception (Stress-CAT), in terms of the two dimensions: exposure to stress and stress reaction. STUDY DESIGN AND SETTING: Item response theory modeling was performed using a two-parameter model (Generalized Partial Credit Model). The evaluation of the Stress-CAT comprised a simulation study and real clinical application. A total of 1,092 psychosomatic patients (N1) were studied. Two hundred simulees (N2) were generated for a simulated response data set. Then the Stress-CAT was given to n=116 inpatients, (N3) together with established stress questionnaires as validity criteria. RESULTS: The final banks included n=38 stress exposure items and n=31 stress reaction items. In the first simulation study, CAT scores could be estimated with a high measurement precision (SE<0.32; rho>0.90) using 7.0+/-2.3 (M+/-SD) stress reaction items and 11.6+/-1.7 stress exposure items. The second simulation study reanalyzed real patients data (N1) and showed an average use of items of 5.6+/-2.1 for the dimension stress reaction and 10.0+/-4.9 for the dimension stress exposure. Convergent validity showed significantly high correlations. CONCLUSIONS: The Stress-CAT is short and precise, potentially lowering the response burden of patients in clinical decision making. %B Journal of Clinical Epidemiology %7 2008/07/22 %V 62 %P 278-287 %@ 1878-5921 (Electronic)0895-4356 (Linking) %G eng %M 18639439 %0 Journal Article %J Quality of Life Research %D 2009 %T Replenishing a computerized adaptive test of patient-reported daily activity functioning %A Haley, S. M. %A Ni, P. %A Jette, A. M. %A Tao, W. %A Moed, R. %A Meyers, D. %A Ludlow, L. H. %K *Activities of Daily Living %K *Disability Evaluation %K *Questionnaires %K *User-Computer Interface %K Adult %K Aged %K Cohort Studies %K Computer-Assisted Instruction %K Female %K Humans %K Male %K Middle Aged %K Outcome Assessment (Health Care)/*methods %X 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. %B Quality of Life Research %7 2009/03/17 %V 18 %P 461-71 %8 May %@ 0962-9343 (Print)0962-9343 (Linking) %G eng %M 19288222 %0 Journal Article %J Archives of Physical Medicine and Rehabilitation %D 2008 %T Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: II. Participation outcomes %A Haley, S. M. %A Gandek, B. %A Siebens, H. %A Black-Schaffer, R. M. %A Sinclair, S. J. %A Tao, W. %A Coster, W. J. %A Ni, P. %A Jette, A. M. %K *Activities of Daily Living %K *Adaptation, Physiological %K *Computer Systems %K *Questionnaires %K Adult %K Aged %K Aged, 80 and over %K Chi-Square Distribution %K Factor Analysis, Statistical %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Outcome Assessment (Health Care)/*methods %K Patient Discharge %K Prospective Studies %K Rehabilitation/*standards %K Subacute Care/*standards %X 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. %B Archives of Physical Medicine and Rehabilitation %7 2008/01/30 %V 89 %P 275-283 %8 Feb %@ 1532-821X (Electronic)0003-9993 (Linking) %G eng %M 18226651 %2 2666330 %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 Spine %D 2008 %T Letting the CAT out of the bag: Comparing computer adaptive tests and an 11-item short form of the Roland-Morris Disability Questionnaire %A Cook, K. F. %A Choi, S. W. %A Crane, P. K. %A Deyo, R. A. %A Johnson, K. L. %A Amtmann, D. %K *Disability Evaluation %K *Health Status Indicators %K Adult %K Aged %K Aged, 80 and over %K Back Pain/*diagnosis/psychology %K Calibration %K Computer Simulation %K Diagnosis, Computer-Assisted/*standards %K Humans %K Middle Aged %K Models, Psychological %K Predictive Value of Tests %K Questionnaires/*standards %K Reproducibility of Results %X STUDY DESIGN: A post hoc simulation of a computer adaptive administration of the items of a modified version of the Roland-Morris Disability Questionnaire. OBJECTIVE: To evaluate the effectiveness of adaptive administration of back pain-related disability items compared with a fixed 11-item short form. SUMMARY OF BACKGROUND DATA: Short form versions of the Roland-Morris Disability Questionnaire have been developed. An alternative to paper-and-pencil short forms is to administer items adaptively so that items are presented based on a person's responses to previous items. Theoretically, this allows precise estimation of back pain disability with administration of only a few items. MATERIALS AND METHODS: Data were gathered from 2 previously conducted studies of persons with back pain. An item response theory model was used to calibrate scores based on all items, items of a paper-and-pencil short form, and several computer adaptive tests (CATs). RESULTS: Correlations between each CAT condition and scores based on a 23-item version of the Roland-Morris Disability Questionnaire ranged from 0.93 to 0.98. Compared with an 11-item short form, an 11-item CAT produced scores that were significantly more highly correlated with scores based on the 23-item scale. CATs with even fewer items also produced scores that were highly correlated with scores based on all items. For example, scores from a 5-item CAT had a correlation of 0.93 with full scale scores. Seven- and 9-item CATs correlated at 0.95 and 0.97, respectively. A CAT with a standard-error-based stopping rule produced scores that correlated at 0.95 with full scale scores. CONCLUSION: A CAT-based back pain-related disability measure may be a valuable tool for use in clinical and research contexts. Use of CAT for other common measures in back pain research, such as other functional scales or measures of psychological distress, may offer similar advantages. %B Spine %7 2008/05/23 %V 33 %P 1378-83 %8 May 20 %@ 1528-1159 (Electronic) %G eng %M 18496352 %0 Journal Article %J Psychiatric Services %D 2008 %T Using computerized adaptive testing to reduce the burden of mental health assessment %A Gibbons, R. D. %A Weiss, D. J. %A Kupfer, D. J. %A Frank, E. %A Fagiolini, A. %A Grochocinski, V. J. %A Bhaumik, D. K. %A Stover, A. %A Bock, R. D. %A Immekus, J. C. %K *Diagnosis, Computer-Assisted %K *Questionnaires %K Adolescent %K Adult %K Aged %K Agoraphobia/diagnosis %K Anxiety Disorders/diagnosis %K Bipolar Disorder/diagnosis %K Female %K Humans %K Male %K Mental Disorders/*diagnosis %K Middle Aged %K Mood Disorders/diagnosis %K Obsessive-Compulsive Disorder/diagnosis %K Panic Disorder/diagnosis %K Phobic Disorders/diagnosis %K Reproducibility of Results %K Time Factors %X OBJECTIVE: This study investigated the combination of item response theory and computerized adaptive testing (CAT) for psychiatric measurement as a means of reducing the burden of research and clinical assessments. METHODS: Data were from 800 participants in outpatient treatment for a mood or anxiety disorder; they completed 616 items of the 626-item Mood and Anxiety Spectrum Scales (MASS) at two times. The first administration was used to design and evaluate a CAT version of the MASS by using post hoc simulation. The second confirmed the functioning of CAT in live testing. RESULTS: Tests of competing models based on item response theory supported the scale's bifactor structure, consisting of a primary dimension and four group factors (mood, panic-agoraphobia, obsessive-compulsive, and social phobia). Both simulated and live CAT showed a 95% average reduction (585 items) in items administered (24 and 30 items, respectively) compared with administration of the full MASS. The correlation between scores on the full MASS and the CAT version was .93. For the mood disorder subscale, differences in scores between two groups of depressed patients--one with bipolar disorder and one without--on the full scale and on the CAT showed effect sizes of .63 (p<.003) and 1.19 (p<.001) standard deviation units, respectively, indicating better discriminant validity for CAT. CONCLUSIONS: Instead of using small fixed-length tests, clinicians can create item banks with a large item pool, and a small set of the items most relevant for a given individual can be administered with no loss of information, yielding a dramatic reduction in administration time and patient and clinician burden. %B Psychiatric Services %7 2008/04/02 %V 59 %P 361-8 %8 Apr %@ 1075-2730 (Print) %G eng %M 18378832 %0 Journal Article %J Psychological Assessment %D 2007 %T Computerized adaptive personality testing: A review and illustration with the MMPI-2 Computerized Adaptive Version %A Forbey, J. D. %A Ben-Porath, Y. S. %K Adolescent %K Adult %K Diagnosis, Computer-Assisted/*statistics & numerical data %K Female %K Humans %K Male %K MMPI/*statistics & numerical data %K Personality Assessment/*statistics & numerical data %K Psychometrics/statistics & numerical data %K Reference Values %K Reproducibility of Results %X Computerized adaptive testing in personality assessment can improve efficiency by significantly reducing the number of items administered to answer an assessment question. Two approaches have been explored for adaptive testing in computerized personality assessment: item response theory and the countdown method. In this article, the authors review the literature on each and report the results of an investigation designed to explore the utility, in terms of item and time savings, and validity, in terms of correlations with external criterion measures, of an expanded countdown method-based research version of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the MMPI-2 Computerized Adaptive Version (MMPI-2-CA). Participants were 433 undergraduate college students (170 men and 263 women). Results indicated considerable item savings and corresponding time savings for the adaptive testing modalities compared with a conventional computerized MMPI-2 administration. Furthermore, computerized adaptive administration yielded comparable results to computerized conventional administration of the MMPI-2 in terms of both test scores and their validity. Future directions for computerized adaptive personality testing are discussed. %B Psychological Assessment %7 2007/03/21 %V 19 %P 14-24 %8 Mar %@ 1040-3590 (Print) %G eng %M 17371120 %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 Journal of Clinical Epidemiology %D 2006 %T Computer adaptive testing improved accuracy and precision of scores over random item selection in a physical functioning item bank %A Haley, S. M. %A Ni, P. %A Hambleton, R. K. %A Slavin, M. D. %A Jette, A. M. %K *Recovery of Function %K Activities of Daily Living %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Confidence Intervals %K Factor Analysis, Statistical %K Female %K Humans %K Male %K Middle Aged %K Outcome Assessment (Health Care)/*methods %K Rehabilitation/*standards %K Reproducibility of Results %K Software %X 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. %B Journal of Clinical Epidemiology %7 2006/10/10 %V 59 %P 1174-82 %8 Nov %@ 0895-4356 (Print) %G eng %M 17027428 %0 Journal Article %J Archives of Physical Medicine and Rehabilitation %D 2006 %T Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: I. Activity outcomes %A Haley, S. M. %A Siebens, H. %A Coster, W. J. %A Tao, W. %A Black-Schaffer, R. M. %A Gandek, B. %A Sinclair, S. J. %A Ni, P. %K *Activities of Daily Living %K *Adaptation, Physiological %K *Computer Systems %K *Questionnaires %K Adult %K Aged %K Aged, 80 and over %K Chi-Square Distribution %K Factor Analysis, Statistical %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Outcome Assessment (Health Care)/*methods %K Patient Discharge %K Prospective Studies %K Rehabilitation/*standards %K Subacute Care/*standards %X OBJECTIVE: To examine score agreement, precision, validity, efficiency, and responsiveness of a computerized adaptive testing (CAT) version of the Activity Measure for Post-Acute Care (AM-PAC-CAT) in a prospective, 3-month follow-up sample of inpatient rehabilitation patients recently discharged home. DESIGN: Longitudinal, prospective 1-group cohort study of patients followed approximately 2 weeks after hospital discharge and then 3 months after the initial home visit. SETTING: Follow-up visits conducted in patients' home setting. PARTICIPANTS: Ninety-four adults who were recently discharged from inpatient rehabilitation, with diagnoses of neurologic, orthopedic, and medically complex conditions. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Summary scores from AM-PAC-CAT, including 3 activity domains of movement and physical, personal care and instrumental, and applied cognition were compared with scores from a traditional fixed-length version of the AM-PAC with 66 items (AM-PAC-66). RESULTS: AM-PAC-CAT scores were in good agreement (intraclass correlation coefficient model 3,1 range, .77-.86) with scores from the AM-PAC-66. On average, the CAT programs required 43% of the time and 33% of the items compared with the AM-PAC-66. Both formats discriminated across functional severity groups. The standardized response mean (SRM) was greater for the movement and physical fixed form than the CAT; the effect size and SRM of the 2 other AM-PAC domains showed similar sensitivity between CAT and fixed formats. Using patients' own report as an anchor-based measure of change, the CAT and fixed length formats were comparable in responsiveness to patient-reported change over a 3-month interval. CONCLUSIONS: Accurate estimates for functional activity group-level changes can be obtained from CAT administrations, with a considerable reduction in administration time. %B Archives of Physical Medicine and Rehabilitation %7 2006/08/01 %V 87 %P 1033-42 %8 Aug %@ 0003-9993 (Print) %G eng %M 16876547 %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 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 Journal of Clinical Epidemiology %D 2006 %T Simulated computerized adaptive test for patients with shoulder impairments was efficient and produced valid measures of function %A Hart, D. L. %A Cook, K. F. %A Mioduski, J. E. %A Teal, C. R. %A Crane, P. K. %K *Computer Simulation %K *Range of Motion, Articular %K Activities of Daily Living %K Adult %K Aged %K Aged, 80 and over %K Factor Analysis, Statistical %K Female %K Humans %K Male %K Middle Aged %K Prospective Studies %K Reproducibility of Results %K Research Support, N.I.H., Extramural %K Research Support, U.S. Gov't, Non-P.H.S. %K Shoulder Dislocation/*physiopathology/psychology/rehabilitation %K Shoulder Pain/*physiopathology/psychology/rehabilitation %K Shoulder/*physiopathology %K Sickness Impact Profile %K Treatment Outcome %X 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. %B Journal of Clinical Epidemiology %V 59 %P 290-8 %G eng %M 16488360 %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 Journal of Clinical Epidemiology %D 2005 %T An item bank was created to improve the measurement of cancer-related fatigue %A Lai, J-S. %A Cella, D. %A Dineen, K. %A Bode, R. %A Von Roenn, J. %A Gershon, R. C. %A Shevrin, D. %K Adult %K Aged %K Aged, 80 and over %K Factor Analysis, Statistical %K Fatigue/*etiology/psychology %K Female %K Humans %K Male %K Middle Aged %K Neoplasms/*complications/psychology %K Psychometrics %K Questionnaires %X OBJECTIVE: Cancer-related fatigue (CRF) is one of the most common unrelieved symptoms experienced by patients. CRF is underrecognized and undertreated due to a lack of clinically sensitive instruments that integrate easily into clinics. Modern computerized adaptive testing (CAT) can overcome these obstacles by enabling precise assessment of fatigue without requiring the administration of a large number of questions. A working item bank is essential for development of a CAT platform. The present report describes the building of an operational item bank for use in clinical settings with the ultimate goal of improving CRF identification and treatment. STUDY DESIGN AND SETTING: The sample included 301 cancer patients. Psychometric properties of items were examined by using Rasch analysis, an Item Response Theory (IRT) model. RESULTS AND CONCLUSION: The final bank includes 72 items. These 72 unidimensional items explained 57.5% of the variance, based on factor analysis results. Excellent internal consistency (alpha=0.99) and acceptable item-total correlation were found (range: 0.51-0.85). The 72 items covered a reasonable range of the fatigue continuum. No significant ceiling effects, floor effects, or gaps were found. A sample short form was created for demonstration purposes. The resulting bank is amenable to the development of a CAT platform. %B Journal of Clinical Epidemiology %7 2005/02/01 %V 58 %P 190-7 %8 Feb %@ 0895-4356 (Print)0895-4356 (Linking) %G eng %9 Multicenter Study %M 15680754 %0 Journal Article %J American Journal of Physical Medicine and Rehabilitation %D 2005 %T Measuring physical function in patients with complex medical and postsurgical conditions: a computer adaptive approach %A Siebens, H. %A Andres, P. L. %A Pengsheng, N. %A Coster, W. J. %A Haley, S. M. %K Activities of Daily Living/*classification %K Adult %K Aged %K Cohort Studies %K Continuity of Patient Care %K Disability Evaluation %K Female %K Health Services Research %K Humans %K Male %K Middle Aged %K Postoperative Care/*rehabilitation %K Prognosis %K Recovery of Function %K Rehabilitation Centers %K Rehabilitation/*standards %K Sensitivity and Specificity %K Sickness Impact Profile %K Treatment Outcome %X 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. %B American Journal of Physical Medicine and Rehabilitation %V 84 %P 741-8 %8 Oct %G eng %M 16205429 %0 Journal Article %J Journal of Clinical Epidemiology %D 2005 %T Simulated computerized adaptive tests for measuring functional status were efficient with good discriminant validity in patients with hip, knee, or foot/ankle impairments %A Hart, D. L. %A Mioduski, J. E. %A Stratford, P. W. %K *Health Status Indicators %K Activities of Daily Living %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Ankle Joint/physiopathology %K Diagnosis, Computer-Assisted/*methods %K Female %K Hip Joint/physiopathology %K Humans %K Joint Diseases/physiopathology/*rehabilitation %K Knee Joint/physiopathology %K Lower Extremity/*physiopathology %K Male %K Middle Aged %K Research Support, N.I.H., Extramural %K Research Support, U.S. Gov't, P.H.S. %K Retrospective Studies %X 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. %B Journal of Clinical Epidemiology %V 58 %P 629-38 %G eng %M 15878477 %0 Journal Article %J Medical Care %D 2004 %T Activity outcome measurement for postacute care %A Haley, S. M. %A Coster, W. J. %A Andres, P. L. %A Ludlow, L. H. %A Ni, P. %A Bond, T. L. %A Sinclair, S. J. %A Jette, A. M. %K *Self Efficacy %K *Sickness Impact Profile %K Activities of Daily Living/*classification/psychology %K Adult %K Aftercare/*standards/statistics & numerical data %K Aged %K Boston %K Cognition/physiology %K Disability Evaluation %K Factor Analysis, Statistical %K Female %K Human %K Male %K Middle Aged %K Movement/physiology %K Outcome Assessment (Health Care)/*methods/statistics & numerical data %K Psychometrics %K Questionnaires/standards %K Rehabilitation/*standards/statistics & numerical data %K Reproducibility of Results %K Sensitivity and Specificity %K Support, U.S. Gov't, Non-P.H.S. %K Support, U.S. Gov't, P.H.S. %X 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. %B Medical Care %V 42 %P I49-161 %G eng %M 14707755 %0 Generic %D 2004 %T The AMC Linear Disability Score project in a population requiring residential care: psychometric properties %A Holman, R. %A Lindeboom, R. %A Vermeulen, M. %A de Haan, R. J. %K *Disability Evaluation %K *Health Status Indicators %K Activities of Daily Living/*classification %K Adult %K Aged %K Aged, 80 and over %K Data Collection/methods %K Female %K Humans %K Logistic Models %K Male %K Middle Aged %K Netherlands %K Pilot Projects %K Probability %K Psychometrics/*instrumentation %K Questionnaires/standards %K Residential Facilities/*utilization %K Severity of Illness Index %X BACKGROUND: Currently there is a lot of interest in the flexible framework offered by item banks for measuring patient relevant outcomes, including functional status. However, there are few item banks, which have been developed to quantify functional status, as expressed by the ability to perform activities of daily life. METHOD: This paper examines the psychometric properties of the AMC Linear Disability Score (ALDS) project item bank using an item response theory model and full information factor analysis. Data were collected from 555 respondents on a total of 160 items. RESULTS: Following the analysis, 79 items remained in the item bank. The remaining 81 items were excluded because of: difficulties in presentation (1 item); low levels of variation in response pattern (28 items); significant differences in measurement characteristics for males and females or for respondents under or over 85 years old (26 items); or lack of model fit to the data at item level (26 items). CONCLUSIONS: It is conceivable that the item bank will have different measurement characteristics for other patient or demographic populations. However, these results indicate that the ALDS item bank has sound psychometric properties for respondents in residential care settings and could form a stable base for measuring functional status in a range of situations, including the implementation of computerised adaptive testing of functional status. %B Health and Quality of Life Outcomes %7 2004/08/05 %V 2 %P 42 %8 Aug 3 %@ 1477-7525 (Electronic)1477-7525 (Linking) %G eng %M 15291958 %2 514531 %0 Journal Article %J Stroke Rehabilitation %D 2004 %T Computer adaptive testing: a strategy for monitoring stroke rehabilitation across settings %A Andres, P. L. %A Black-Schaffer, R. M. %A Ni, P. %A Haley, S. M. %K *Computer Simulation %K *User-Computer Interface %K Adult %K Aged %K Aged, 80 and over %K Cerebrovascular Accident/*rehabilitation %K Disabled Persons/*classification %K Female %K Humans %K Male %K Middle Aged %K Monitoring, Physiologic/methods %K Severity of Illness Index %K Task Performance and Analysis %X Current functional assessment instruments in stroke rehabilitation are often setting-specific and lack precision, breadth, and/or feasibility. Computer adaptive testing (CAT) offers a promising potential solution by providing a quick, yet precise, measure of function that can be used across a broad range of patient abilities and in multiple settings. CAT technology yields a precise score by selecting very few relevant items from a large and diverse item pool based on each individual's responses. We demonstrate the potential usefulness of a CAT assessment model with a cross-sectional sample of persons with stroke from multiple rehabilitation settings. %B Stroke Rehabilitation %7 2004/05/01 %V 11 %P 33-39 %8 Spring %@ 1074-9357 (Print) %G eng %M 15118965 %0 Journal Article %J BMC Psychiatry %D 2004 %T Computerized adaptive measurement of depression: A simulation study %A Gardner, W. %A Shear, K. %A Kelleher, K. J. %A Pajer, K. A. %A Mammen, O. %A Buysse, D. %A Frank, E. %K *Computer Simulation %K Adult %K Algorithms %K Area Under Curve %K Comparative Study %K Depressive Disorder/*diagnosis/epidemiology/psychology %K Diagnosis, Computer-Assisted/*methods/statistics & numerical data %K Factor Analysis, Statistical %K Female %K Humans %K Internet %K Male %K Mass Screening/methods %K Patient Selection %K Personality Inventory/*statistics & numerical data %K Pilot Projects %K Prevalence %K Psychiatric Status Rating Scales/*statistics & numerical data %K Psychometrics %K Research Support, Non-U.S. Gov't %K Research Support, U.S. Gov't, P.H.S. %K Severity of Illness Index %K Software %X Background: Efficient, accurate instruments for measuring depression are increasingly importantin clinical practice. We developed a computerized adaptive version of the Beck DepressionInventory (BDI). We examined its efficiency and its usefulness in identifying Major DepressiveEpisodes (MDE) and in measuring depression severity.Methods: Subjects were 744 participants in research studies in which each subject completed boththe BDI and the SCID. In addition, 285 patients completed the Hamilton Depression Rating Scale.Results: The adaptive BDI had an AUC as an indicator of a SCID diagnosis of MDE of 88%,equivalent to the full BDI. The adaptive BDI asked fewer questions than the full BDI (5.6 versus 21items). The adaptive latent depression score correlated r = .92 with the BDI total score and thelatent depression score correlated more highly with the Hamilton (r = .74) than the BDI total scoredid (r = .70).Conclusions: Adaptive testing for depression may provide greatly increased efficiency withoutloss of accuracy in identifying MDE or in measuring depression severity. %B BMC Psychiatry %V 4 %P 13-23 %G eng %M 15132755 %0 Journal Article %J Medical Care %D 2004 %T Refining the conceptual basis for rehabilitation outcome measurement: personal care and instrumental activities domain %A Coster, W. J. %A Haley, S. M. %A Andres, P. L. %A Ludlow, L. H. %A Bond, T. L. %A Ni, P. S. %K *Self Efficacy %K *Sickness Impact Profile %K Activities of Daily Living/*classification/psychology %K Adult %K Aged %K Aged, 80 and over %K Disability Evaluation %K Factor Analysis, Statistical %K Female %K Humans %K Male %K Middle Aged %K Outcome Assessment (Health Care)/*methods/statistics & numerical data %K Questionnaires/*standards %K Recovery of Function/physiology %K Rehabilitation/*standards/statistics & numerical data %K Reproducibility of Results %K Research Support, U.S. Gov't, Non-P.H.S. %K Research Support, U.S. Gov't, P.H.S. %K Sensitivity and Specificity %X BACKGROUND: Rehabilitation outcome measures routinely include content on performance of daily activities; however, the conceptual basis for item selection is rarely specified. These instruments differ significantly in format, number, and specificity of daily activity items and in the measurement dimensions and type of scale used to specify levels of performance. We propose that a requirement for upper limb and hand skills underlies many activities of daily living (ADL) and instrumental activities of daily living (IADL) items in current instruments, and that items selected based on this definition can be placed along a single functional continuum. OBJECTIVE: To examine the dimensional structure and content coverage of a Personal Care and Instrumental Activities item set and to examine the comparability of items from existing instruments and a set of new items as measures of this domain. METHODS: Participants (N = 477) from 3 different disability groups and 4 settings representing the continuum of postacute rehabilitation care were administered the newly developed Activity Measure for Post-Acute Care (AM-PAC), the SF-8, and an additional setting-specific measure: FIM (in-patient rehabilitation); MDS (skilled nursing facility); MDS-PAC (postacute settings); OASIS (home care); or PF-10 (outpatient clinic). Rasch (partial-credit model) analyses were conducted on a set of 62 items covering the Personal Care and Instrumental domain to examine item fit, item functioning, and category difficulty estimates and unidimensionality. RESULTS: After removing 6 misfitting items, the remaining 56 items fit acceptably along the hypothesized continuum. Analyses yielded different difficulty estimates for the maximum score (eg, "Independent performance") for items with comparable content from different instruments. Items showed little differential item functioning across age, diagnosis, or severity groups, and 92% of the participants fit the model. CONCLUSIONS: ADL and IADL items from existing rehabilitation outcomes instruments that depend on skilled upper limb and hand use can be located along a single continuum, along with the new personal care and instrumental items of the AM-PAC addressing gaps in content. Results support the validity of the proposed definition of the Personal Care and Instrumental Activities dimension of function as a guide for future development of rehabilitation outcome instruments, such as linked, setting-specific short forms and computerized adaptive testing approaches. %B Medical Care %V 42 %P I62-172 %8 Jan %G eng %M 14707756 %0 Journal Article %J Quality of Life Research %D 2003 %T Calibration of an item pool for assessing the burden of headaches: an application of item response theory to the Headache Impact Test (HIT) %A Bjorner, J. B. %A Kosinski, M. %A Ware, J. E., Jr. %K *Cost of Illness %K *Decision Support Techniques %K *Sickness Impact Profile %K Adolescent %K Adult %K Aged %K Comparative Study %K Disability Evaluation %K Factor Analysis, Statistical %K Headache/*psychology %K Health Surveys %K Human %K Longitudinal Studies %K Middle Aged %K Migraine/psychology %K Models, Psychological %K Psychometrics/*methods %K Quality of Life/*psychology %K Software %K Support, Non-U.S. Gov't %X BACKGROUND: Measurement of headache impact is important in clinical trials, case detection, and the clinical monitoring of patients. Computerized adaptive testing (CAT) of headache impact has potential advantages over traditional fixed-length tests in terms of precision, relevance, real-time quality control and flexibility. OBJECTIVE: To develop an item pool that can be used for a computerized adaptive test of headache impact. METHODS: We analyzed responses to four well-known tests of headache impact from a population-based sample of recent headache sufferers (n = 1016). We used confirmatory factor analysis for categorical data and analyses based on item response theory (IRT). RESULTS: In factor analyses, we found very high correlations between the factors hypothesized by the original test constructers, both within and between the original questionnaires. These results suggest that a single score of headache impact is sufficient. We established a pool of 47 items which fitted the generalized partial credit IRT model. By simulating a computerized adaptive health test we showed that an adaptive test of only five items had a very high concordance with the score based on all items and that different worst-case item selection scenarios did not lead to bias. CONCLUSION: We have established a headache impact item pool that can be used in CAT of headache impact. %B Quality of Life Research %V 12 %P 913-933 %G eng %M 14661767 %0 Journal Article %J Quality of Life Research %D 2003 %T The feasibility of applying item response theory to measures of migraine impact: a re-analysis of three clinical studies %A Bjorner, J. B. %A Kosinski, M. %A Ware, J. E., Jr. %K *Sickness Impact Profile %K Adolescent %K Adult %K Aged %K Comparative Study %K Cost of Illness %K Factor Analysis, Statistical %K Feasibility Studies %K Female %K Human %K Male %K Middle Aged %K Migraine/*psychology %K Models, Psychological %K Psychometrics/instrumentation/*methods %K Quality of Life/*psychology %K Questionnaires %K Support, Non-U.S. Gov't %X BACKGROUND: Item response theory (IRT) is a powerful framework for analyzing multiitem scales and is central to the implementation of computerized adaptive testing. OBJECTIVES: To explain the use of IRT to examine measurement properties and to apply IRT to a questionnaire for measuring migraine impact--the Migraine Specific Questionnaire (MSQ). METHODS: Data from three clinical studies that employed the MSQ-version 1 were analyzed by confirmatory factor analysis for categorical data and by IRT modeling. RESULTS: Confirmatory factor analyses showed very high correlations between the factors hypothesized by the original test constructions. Further, high item loadings on one common factor suggest that migraine impact may be adequately assessed by only one score. IRT analyses of the MSQ were feasible and provided several suggestions as to how to improve the items and in particular the response choices. Out of 15 items, 13 showed adequate fit to the IRT model. In general, IRT scores were strongly associated with the scores proposed by the original test developers and with the total item sum score. Analysis of response consistency showed that more than 90% of the patients answered consistently according to a unidimensional IRT model. For the remaining patients, scores on the dimension of emotional function were less strongly related to the overall IRT scores that mainly reflected role limitations. Such response patterns can be detected easily using response consistency indices. Analysis of test precision across score levels revealed that the MSQ was most precise at one standard deviation worse than the mean impact level for migraine patients that are not in treatment. Thus, gains in test precision can be achieved by developing items aimed at less severe levels of migraine impact. CONCLUSIONS: IRT proved useful for analyzing the MSQ. The approach warrants further testing in a more comprehensive item pool for headache impact that would enable computerized adaptive testing. %B Quality of Life Research %V 12 %P 887-902 %G eng %M 14661765 %0 Journal Article %J Quality of Life Research %D 2003 %T Item banking to improve, shorten and computerized self-reported fatigue: an illustration of steps to create a core item bank from the FACIT-Fatigue Scale %A Lai, J-S. %A Crane, P. K. %A Cella, D. %A Chang, C-H. %A Bode, R. K. %A Heinemann, A. W. %K *Health Status Indicators %K *Questionnaires %K Adult %K Fatigue/*diagnosis/etiology %K Female %K Humans %K Male %K Middle Aged %K Neoplasms/complications %K Psychometrics %K Research Support, Non-U.S. Gov't %K Research Support, U.S. Gov't, P.H.S. %K Sickness Impact Profile %X Fatigue is a common symptom among cancer patients and the general population. Due to its subjective nature, fatigue has been difficult to effectively and efficiently assess. Modern computerized adaptive testing (CAT) can enable precise assessment of fatigue using a small number of items from a fatigue item bank. CAT enables brief assessment by selecting questions from an item bank that provide the maximum amount of information given a person's previous responses. This article illustrates steps to prepare such an item bank, using 13 items from the Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-F) as the basis. Samples included 1022 cancer patients and 1010 people from the general population. An Item Response Theory (IRT)-based rating scale model, a polytomous extension of the Rasch dichotomous model was utilized. Nine items demonstrating acceptable psychometric properties were selected and positioned on the fatigue continuum. The fatigue levels measured by these nine items along with their response categories covered 66.8% of the general population and 82.6% of the cancer patients. Although the operational CAT algorithms to handle polytomously scored items are still in progress, we illustrated how CAT may work by using nine core items to measure level of fatigue. Using this illustration, a fatigue measure comparable to its full-length 13-item scale administration was obtained using four items. The resulting item bank can serve as a core to which will be added a psychometrically sound and operational item bank covering the entire fatigue continuum. %B Quality of Life Research %V 12 %P 485-501 %8 Aug %G eng %M 13677494 %0 Journal Article %J Drug and Alcohol Dependence %D 2002 %T Assessing tobacco beliefs among youth using item response theory models %A Panter, A. T. %A Reeve, B. B. %K *Attitude to Health %K *Culture %K *Health Behavior %K *Questionnaires %K Adolescent %K Adult %K Child %K Female %K Humans %K Male %K Models, Statistical %K Smoking/*epidemiology %X Successful intervention research programs to prevent adolescent smoking require well-chosen, psychometrically sound instruments for assessing smoking prevalence and attitudes. Twelve thousand eight hundred and ten adolescents were surveyed about their smoking beliefs as part of the Teenage Attitudes and Practices Survey project, a prospective cohort study of predictors of smoking initiation among US adolescents. Item response theory (IRT) methods are used to frame a discussion of questions that a researcher might ask when selecting an optimal item set. IRT methods are especially useful for choosing items during instrument development, trait scoring, evaluating item functioning across groups, and creating optimal item subsets for use in specialized applications such as computerized adaptive testing. Data analytic steps for IRT modeling are reviewed for evaluating item quality and differential item functioning across subgroups of gender, age, and smoking status. Implications and challenges in the use of these methods for tobacco onset research and for assessing the developmental trajectories of smoking among youth are discussed. %B Drug and Alcohol Dependence %V 68 %P S21-S39 %8 Nov %G eng %M 12324173 %0 Journal Article %J Archives of Physical Medicine and Rehabilitation %D 2002 %T Development of an index of physical functional health status in rehabilitation %A Hart, D. L. %A Wright, B. D. %K *Health Status Indicators %K *Rehabilitation Centers %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Female %K Health Surveys %K Humans %K Male %K Middle Aged %K Musculoskeletal Diseases/*physiopathology/*rehabilitation %K Nervous System Diseases/*physiopathology/*rehabilitation %K Physical Fitness/*physiology %K Recovery of Function/physiology %K Reproducibility of Results %K Retrospective Studies %X 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. %B Archives of Physical Medicine and Rehabilitation %V 83 %P 655-65 %8 May %G eng %M 11994805 %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 Journal of Applied Psychology %D 2001 %T An examination of the comparative reliability, validity, and accuracy of performance ratings made using computerized adaptive rating scales %A Borman, W. C. %A Buck, D. E. %A Hanson, M. A. %A Motowidlo, S. J. %A Stark, S. %A F Drasgow %K *Computer Simulation %K *Employee Performance Appraisal %K *Personnel Selection %K Adult %K Automatic Data Processing %K Female %K Human %K Male %K Reproducibility of Results %K Sensitivity and Specificity %K Support, U.S. Gov't, Non-P.H.S. %K Task Performance and Analysis %K Video Recording %X This laboratory research compared the reliability, validity, and accuracy of a computerized adaptive rating scale (CARS) format and 2 relatively common and representative rating formats. The CARS is a paired-comparison rating task that uses adaptive testing principles to present pairs of scaled behavioral statements to the rater to iteratively estimate a ratee's effectiveness on 3 dimensions of contextual performance. Videotaped vignettes of 6 office workers were prepared, depicting prescripted levels of contextual performance, and 112 subjects rated these vignettes using the CARS format and one or the other competing format. Results showed 23%-37% lower standard errors of measurement for the CARS format. In addition, validity was significantly higher for the CARS format (d = .18), and Cronbach's accuracy coefficients showed significantly higher accuracy, with a median effect size of .08. The discussion focuses on possible reasons for the results. %B Journal of Applied Psychology %V 86 %P 965-973 %G eng %M 11596812 %0 Journal Article %J Journal of Professional Nursing %D 2001 %T NCLEX-RN performance: predicting success on the computerized examination %A Beeman, P. B. %A Waterhouse, J. K. %K *Education, Nursing, Baccalaureate %K *Educational Measurement %K *Licensure %K Adult %K Female %K Humans %K Male %K Predictive Value of Tests %K Software %X Since the adoption of the Computerized Adaptive Testing (CAT) format of the National Certification Licensure Examination for Registered Nurses (NCLEX-RN), no studies have been reported in the literature on predictors of successful performance by baccalaureate nursing graduates on the licensure examination. In this study, a discriminant analysis was used to identify which of 21 variables can be significant predictors of success on the CAT NCLEX-RN. The convenience sample consisted of 289 individuals who graduated from a baccalaureate nursing program between 1995 and 1998. Seven significant predictor variables were identified. The total number of C+ or lower grades earned in nursing theory courses was the best predictor, followed by grades in several individual nursing courses. More than 93 per cent of graduates were correctly classified. Ninety-four per cent of NCLEX "passes" were correctly classified, as were 92 per cent of NCLEX failures. This degree of accuracy in classifying CAT NCLEX-RN failures represents a marked improvement over results reported in previous studies of licensure examinations, and suggests the discriminant function will be helpful in identifying future students in danger of failure. J Prof Nurs 17:158-165, 2001. %B Journal of Professional Nursing %V 17 %P 158-165 %8 Jul-Aug %G eng %M 11464336 %0 Journal Article %J Journal of the Accoustical Society of America %D 1997 %T A computerized adaptive testing system for speech discrimination measurement: The Speech Sound Pattern Discrimination Test %A Bochner, J. %A Garrison, W. %A Palmer, L. %A MacKenzie, D. %A Braveman, A. %K *Diagnosis, Computer-Assisted %K *Speech Discrimination Tests %K *Speech Perception %K Adolescent %K Adult %K Audiometry, Pure-Tone %K Human %K Middle Age %K Psychometrics %K Reproducibility of Results %X A computerized, adaptive test-delivery system for the measurement of speech discrimination, the Speech Sound Pattern Discrimination Test, is described and evaluated. Using a modified discrimination task, the testing system draws on a pool of 130 items spanning a broad range of difficulty to estimate an examinee's location along an underlying continuum of speech processing ability, yet does not require the examinee to possess a high level of English language proficiency. The system is driven by a mathematical measurement model which selects only test items which are appropriate in difficulty level for a given examinee, thereby individualizing the testing experience. Test items were administered to a sample of young deaf adults, and the adaptive testing system evaluated in terms of respondents' sensory and perceptual capabilities, acoustic and phonetic dimensions of speech, and theories of speech perception. Data obtained in this study support the validity, reliability, and efficiency of this test as a measure of speech processing ability. %B Journal of the Accoustical Society of America %V 101 %P 2289-298 %G eng %M 9104030 %0 Journal Article %J Shinrigaku Kenkyu %D 1995 %T A study of psychologically optimal level of item difficulty %A Fujimori, S. %K *Adaptation, Psychological %K *Psychological Tests %K Adult %K Female %K Humans %K Male %X For the purpose of selecting items in a test, this study presented a viewpoint of psychologically optimal difficulty level, as well as measurement efficiency, of items. A paper-and-pencil test (P & P) composed of hard, moderate and easy subtests was administered to 298 students at a university. A computerized adaptive test (CAT) was also administered to 79 students. The items of both tests were selected from Shiba's Word Meaning Comprehension Test, for which the estimates of parameters of two-parameter item response model were available. The results of P & P research showed that the psychologically optimal success level would be such that the proportion of right answers is somewhere between .75 and .85. A similar result was obtained from CAT research, where the proportion of about .8 might be desirable. Traditionally a success rate of .5 has been recommended in adaptive testing. In this study, however, it was suggested that the items of such level would be too hard psychologically for many examinees. %B Shinrigaku Kenkyu %7 1995/02/01 %V 65 %P 446-53 %8 Feb %@ 0021-5236 (Print)0021-5236 (Linking) %G jpn %M 7752567