TitleAn evaluation of patient-reported outcomes found computerized adaptive testing was efficient in assessing stress perception
Publication TypeJournal Article
Year of Publication2009
AuthorsKocalevent, RD, Rose, M, Becker, J, Walter, OB, Fliege, H, Bjorner, JB, Kleiber, D, Klapp, BF
JournalJournal of Clinical Epidemiology
Publication Languageeng
ISBN Number1878-5921 (Electronic)0895-4356 (Linking)
Accession Number18639439
Keywords*Diagnosis, Computer-Assisted, Adolescent, Adult, Aged, Aged, 80 and over, Confidence Intervals, Female, Humans, Male, Middle Aged, Perception, Quality of Health Care/*standards, Questionnaires, Reproducibility of Results, Sickness Impact Profile, Stress, Psychological/*diagnosis/psychology, Treatment Outcome

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.