@article {184, title = {Simulated computerized adaptive test for patients with shoulder impairments was efficient and produced valid measures of function}, journal = {Journal of Clinical Epidemiology}, volume = {59}, number = {3}, year = {2006}, note = {0895-4356 (Print)Journal ArticleValidation Studies}, pages = {290-8}, abstract = {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.}, keywords = {*Computer Simulation, *Range of Motion, Articular, Activities of Daily Living, Adult, Aged, Aged, 80 and over, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Prospective Studies, Reproducibility of Results, Research Support, N.I.H., Extramural, Research Support, U.S. Gov{\textquoteright}t, Non-P.H.S., Shoulder Dislocation/*physiopathology/psychology/rehabilitation, Shoulder Pain/*physiopathology/psychology/rehabilitation, Shoulder/*physiopathology, Sickness Impact Profile, Treatment Outcome}, author = {Hart, D. L. and Cook, K. F. and Mioduski, J. E. and Teal, C. R. and Crane, P. K.} } @article {211, title = {Contemporary measurement techniques for rehabilitation outcomes assessment}, journal = {Journal of Rehabilitation Medicine}, volume = {37}, number = {6}, year = {2005}, note = {1650-1977 (Print)Journal ArticleReview}, pages = {339-345}, abstract = {In this article, we review the limitations of traditional rehabilitation functional outcome instruments currently in use within the rehabilitation field to assess Activity and Participation domains as defined by the International Classification of Function, Disability, and Health. These include a narrow scope of functional outcomes, data incompatibility across instruments, and the precision vs feasibility dilemma. Following this, we illustrate how contemporary measurement techniques, such as item response theory methods combined with computer adaptive testing methodology, can be applied in rehabilitation to design functional outcome instruments that are comprehensive in scope, accurate, allow for compatibility across instruments, and are sensitive to clinically important change without sacrificing their feasibility. Finally, we present some of the pressing challenges that need to be overcome to provide effective dissemination and training assistance to ensure that current and future generations of rehabilitation professionals are familiar with and skilled in the application of contemporary outcomes measurement.}, keywords = {*Disability Evaluation, Activities of Daily Living/classification, Disabled Persons/classification/*rehabilitation, Health Status Indicators, Humans, Outcome Assessment (Health Care)/*methods/standards, Recovery of Function, Research Support, N.I.H., Extramural, Research Support, U.S. Gov{\textquoteright}t, Non-P.H.S., Sensitivity and Specificity computerized adaptive testing}, author = {Jette, A. M. and Haley, S. M.} } @article {87, title = {Refining the conceptual basis for rehabilitation outcome measurement: personal care and instrumental activities domain}, journal = {Medical Care}, volume = {42}, number = {1 Suppl}, year = {2004}, note = {0025-7079Journal Article}, month = {Jan}, pages = {I62-172}, abstract = {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.}, keywords = {*Self Efficacy, *Sickness Impact Profile, Activities of Daily Living/*classification/psychology, Adult, Aged, Aged, 80 and over, Disability Evaluation, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Outcome Assessment (Health Care)/*methods/statistics \& numerical data, Questionnaires/*standards, Recovery of Function/physiology, Rehabilitation/*standards/statistics \& numerical data, Reproducibility of Results, Research Support, U.S. Gov{\textquoteright}t, Non-P.H.S., Research Support, U.S. Gov{\textquoteright}t, P.H.S., Sensitivity and Specificity}, author = {Coster, W. J. and Haley, S. M. and Andres, P. L. and Ludlow, L. H. and Bond, T. L. and Ni, P. S.} } @article {274, title = {Ten recommendations for advancing patient-centered outcomes measurement for older persons}, journal = {Annals of Internal Medicine}, volume = {139}, number = {5 Pt 2}, year = {2003}, note = {1539-3704Journal ArticleReview}, month = {Sep 2}, pages = {403-409}, abstract = {The past 50 years have seen great progress in the measurement of patient-based outcomes for older populations. Most of the measures now used were created under the umbrella of a set of assumptions and procedures known as classical test theory. A recent alternative for health status assessment is item response theory. Item response theory is superior to classical test theory because it can eliminate test dependency and achieve more precise measurement through computerized adaptive testing. Computerized adaptive testing reduces test administration times and allows varied and precise estimates of ability. Several key challenges must be met before computerized adaptive testing becomes a productive reality. I discuss these challenges for the health assessment of older persons in the form of 10 "Ds": things we need to deliberate, debate, decide, and do.}, keywords = {*Health Status Indicators, Aged, Geriatric Assessment/*methods, Humans, Patient-Centered Care/*methods, Research Support, U.S. Gov{\textquoteright}t, Non-P.H.S.}, author = {McHorney, C. A.} }