%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 Journal of Rheumatology %D 2009 %T Progress in assessing physical function in arthritis: PROMIS short forms and computerized adaptive testing %A Fries, J.F. %A Cella, D. %A Rose, M. %A Krishnan, E. %A Bruce, B. %K *Disability Evaluation %K *Outcome Assessment (Health Care) %K Arthritis/diagnosis/*physiopathology %K Health Surveys %K Humans %K Prognosis %K Reproducibility of Results %X OBJECTIVE: Assessing self-reported physical function/disability with the Health Assessment Questionnaire Disability Index (HAQ) and other instruments has become central in arthritis research. Item response theory (IRT) and computerized adaptive testing (CAT) techniques can increase reliability and statistical power. IRT-based instruments can improve measurement precision substantially over a wider range of disease severity. These modern methods were applied and the magnitude of improvement was estimated. METHODS: A 199-item physical function/disability item bank was developed by distilling 1865 items to 124, including Legacy Health Assessment Questionnaire (HAQ) and Physical Function-10 items, and improving precision through qualitative and quantitative evaluation in over 21,000 subjects, which included about 1500 patients with rheumatoid arthritis and osteoarthritis. Four new instruments, (A) Patient-Reported Outcomes Measurement Information (PROMIS) HAQ, which evolved from the original (Legacy) HAQ; (B) "best" PROMIS 10; (C) 20-item static (short) forms; and (D) simulated PROMIS CAT, which sequentially selected the most informative item, were compared with the HAQ. RESULTS: Online and mailed administration modes yielded similar item and domain scores. The HAQ and PROMIS HAQ 20-item scales yielded greater information content versus other scales in patients with more severe disease. The "best" PROMIS 20-item scale outperformed the other 20-item static forms over a broad range of 4 standard deviations. The 10-item simulated PROMIS CAT outperformed all other forms. CONCLUSION: Improved items and instruments yielded better information. The PROMIS HAQ is currently available and considered validated. The new PROMIS short forms, after validation, are likely to represent further improvement. CAT-based physical function/disability assessment offers superior performance over static forms of equal length. %B Journal of Rheumatology %7 2009/09/10 %V 36 %P 2061-2066 %8 Sep %@ 0315-162X (Print)0315-162X (Linking) %G eng %M 19738214