%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 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 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