@article {2305, title = {Comparison of two Bayesian methods to detect mode effects between paper-based and computerized adaptive assessments: a preliminary Monte Carlo study.}, journal = {BMC Med Res Methodol}, volume = {12}, year = {2012}, month = {2012}, pages = {124}, abstract = {

BACKGROUND: Computerized adaptive testing (CAT) is being applied to health outcome measures developed as paper-and-pencil (P\&P) instruments. Differences in how respondents answer items administered by CAT vs. P\&P can increase error in CAT-estimated measures if not identified and corrected.

METHOD: Two methods for detecting item-level mode effects are proposed using Bayesian estimation of posterior distributions of item parameters: (1) a modified robust Z (RZ) test, and (2) 95\% credible intervals (CrI) for the CAT-P\&P difference in item difficulty. A simulation study was conducted under the following conditions: (1) data-generating model (one- vs. two-parameter IRT model); (2) moderate vs. large DIF sizes; (3) percentage of DIF items (10\% vs. 30\%), and (4) mean difference in \θ estimates across modes of 0 vs. 1 logits. This resulted in a total of 16 conditions with 10 generated datasets per condition.

RESULTS: Both methods evidenced good to excellent false positive control, with RZ providing better control of false positives and with slightly higher power for CrI, irrespective of measurement model. False positives increased when items were very easy to endorse and when there with mode differences in mean trait level. True positives were predicted by CAT item usage, absolute item difficulty and item discrimination. RZ outperformed CrI, due to better control of false positive DIF.

CONCLUSIONS: Whereas false positives were well controlled, particularly for RZ, power to detect DIF was suboptimal. Research is needed to examine the robustness of these methods under varying prior assumptions concerning the distribution of item and person parameters and when data fail to conform to prior assumptions. False identification of DIF when items were very easy to endorse is a problem warranting additional investigation.

}, keywords = {Bayes Theorem, Data Interpretation, Statistical, Humans, Mathematical Computing, Monte Carlo Method, Outcome Assessment (Health Care)}, issn = {1471-2288}, doi = {10.1186/1471-2288-12-124}, author = {Riley, Barth B and Carle, Adam C} } @article {2, title = {Deterioro de par{\'a}metros de los {\'\i}tems en tests adaptativos informatizados: estudio con eCAT [Item parameter drift in computerized adaptive testing: Study with eCAT]}, journal = {Psicothema}, volume = {22}, number = {2}, year = {2010}, note = {Abad, Francisco JOlea, JulioAguado, DavidPonsoda, VicenteBarrada, Juan REnglish AbstractSpainPsicothemaPsicothema. 2010 May;22(2):340-7.}, pages = {340-7}, edition = {2010/04/29}, abstract = {

En el presente trabajo se muestra el an\álisis realizado sobre un Test Adaptativo Informatizado (TAI) dise\ñado para la evaluaci\ón del nivel de ingl\és, denominado eCAT, con el objetivo de estudiar el deterioro de par\ámetros (parameter drift) producido desde la calibraci\ón inicial del banco de \ítems. Se ha comparado la calibraci\ón original desarrollada para la puesta en servicio del TAI (N= 3224) y la calibraci\ón actual obtenida con las aplicaciones reales del TAI (N= 7254). Se ha analizado el Funcionamiento Diferencial de los \Ítems (FDI) en funci\ón de los par\ámetros utilizados y se ha simulado el impacto que sobre el nivel de rasgo estimado tiene la variaci\ón en los par\ámetros. Los resultados muestran que se produce especialmente un deterioro de los par\ámetros a y c, que hay unimportante n\úmero de \ítems del banco para los que existe FDI y que la variaci\ón de los par\ámetros produce un impacto moderado en la estimaci\ón de \θ de los evaluados con nivel de ingl\és alto. Se concluye que los par\ámetros de los \ítems se han deteriorado y deben ser actualizados.Item parameter drift in computerized adaptive testing: Study with eCAT. This study describes the parameter drift analysis conducted on eCAT (a Computerized Adaptive Test to assess the written English level of Spanish speakers). The original calibration of the item bank (N = 3224) was compared to a new calibration obtained from the data provided by most eCAT operative administrations (N =7254). A Differential Item Functioning (DIF) study was conducted between the original and the new calibrations. The impact that the new parameters have on the trait level estimates was obtained by simulation. Results show that parameter drift is found especially for a and c parameters, an important number of bank items show DIF, and the parameter change has a moderate impact on high-level-English \θ estimates. It is then recommended to replace the original estimates by the new set. by the new set.

}, keywords = {*Software, Educational Measurement/*methods/*statistics \& numerical data, Humans, Language}, isbn = {0214-9915 (Print)0214-9915 (Linking)}, author = {Abad, F. J. and Olea, J. and Aguado, D. and Ponsoda, V. and Barrada, J} } @article {46, title = {Development and validation of patient-reported outcome measures for sleep disturbance and sleep-related impairments}, journal = {Sleep}, volume = {33}, number = {6}, year = {2010}, note = {Buysse, Daniel JYu, LanMoul, Douglas EGermain, AnneStover, AngelaDodds, Nathan EJohnston, Kelly LShablesky-Cade, Melissa APilkonis, Paul AAR052155/AR/NIAMS NIH HHS/United StatesU01AR52155/AR/NIAMS NIH HHS/United StatesU01AR52158/AR/NIAMS NIH HHS/United StatesU01AR52170/AR/NIAMS NIH HHS/United StatesU01AR52171/AR/NIAMS NIH HHS/United StatesU01AR52177/AR/NIAMS NIH HHS/United StatesU01AR52181/AR/NIAMS NIH HHS/United StatesU01AR52186/AR/NIAMS NIH HHS/United StatesResearch Support, N.I.H., ExtramuralValidation StudiesUnited StatesSleepSleep. 2010 Jun 1;33(6):781-92.}, month = {Jun 1}, pages = {781-92}, edition = {2010/06/17}, abstract = {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.}, keywords = {*Outcome Assessment (Health Care), *Self Disclosure, Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Psychometrics, Questionnaires, Reproducibility of Results, Sleep Disorders/*diagnosis, Young Adult}, isbn = {0161-8105 (Print)0161-8105 (Linking)}, author = {Buysse, D. J. and Yu, L. and Moul, D. E. and Germain, A. and Stover, A. and Dodds, N. E. and Johnston, K. L. and Shablesky-Cade, M. A. and Pilkonis, P. A.} } @article {7, title = {Development and preliminary testing of a computerized adaptive assessment of chronic pain}, journal = {Journal of Pain}, volume = {10}, number = {9}, year = {2009}, note = {Anatchkova, Milena DSaris-Baglama, Renee NKosinski, MarkBjorner, Jakob B1R43AR052251-01A1/AR/NIAMS NIH HHS/United StatesEvaluation StudiesResearch Support, N.I.H., ExtramuralUnited StatesThe journal of pain : official journal of the American Pain SocietyJ Pain. 2009 Sep;10(9):932-43.}, month = {Sep}, pages = {932-943}, edition = {2009/07/15}, abstract = {The aim of this article is to report the development and preliminary testing of a prototype computerized adaptive test of chronic pain (CHRONIC PAIN-CAT) conducted in 2 stages: (1) evaluation of various item selection and stopping rules through real data-simulated administrations of CHRONIC PAIN-CAT; (2) a feasibility study of the actual prototype CHRONIC PAIN-CAT assessment system conducted in a pilot sample. Item calibrations developed from a US general population sample (N = 782) were used to program a pain severity and impact item bank (kappa = 45), and real data simulations were conducted to determine a CAT stopping rule. The CHRONIC PAIN-CAT was programmed on a tablet PC using QualityMetric{\textquoteright}s Dynamic Health Assessment (DYHNA) software and administered to a clinical sample of pain sufferers (n = 100). The CAT was completed in significantly less time than the static (full item bank) assessment (P < .001). On average, 5.6 items were dynamically administered by CAT to achieve a precise score. Scores estimated from the 2 assessments were highly correlated (r = .89), and both assessments discriminated across pain severity levels (P < .001, RV = .95). Patients{\textquoteright} evaluations of the CHRONIC PAIN-CAT were favorable. PERSPECTIVE: This report demonstrates that the CHRONIC PAIN-CAT is feasible for administration in a clinic. The application has the potential to improve pain assessment and help clinicians manage chronic pain.}, keywords = {*Computers, *Questionnaires, Activities of Daily Living, Adaptation, Psychological, Chronic Disease, Cohort Studies, Disability Evaluation, Female, Humans, Male, Middle Aged, Models, Psychological, Outcome Assessment (Health Care), Pain Measurement/*methods, Pain, Intractable/*diagnosis/psychology, Psychometrics, Quality of Life, User-Computer Interface}, isbn = {1528-8447 (Electronic)1526-5900 (Linking)}, author = {Anatchkova, M. D. and Saris-Baglama, R. N. and Kosinski, M. and Bjorner, J. B.} } @article {138, title = {Development of an item bank for the assessment of depression in persons with mental illnesses and physical diseases using Rasch analysis}, journal = {Rehabilitation Psychology}, volume = {54}, number = {2}, year = {2009}, note = {Forkmann, ThomasBoecker, MarenNorra, ChristineEberle, NicoleKircher, TiloSchauerte, PatrickMischke, KarlWesthofen, MartinGauggel, SiegfriedWirtz, MarkusResearch Support, Non-U.S. Gov{\textquoteright}tUnited StatesRehabilitation psychologyRehabil Psychol. 2009 May;54(2):186-97.}, month = {May}, pages = {186-97}, edition = {2009/05/28}, abstract = {OBJECTIVE: The calibration of item banks provides the basis for computerized adaptive testing that ensures high diagnostic precision and minimizes participants{\textquoteright} 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.}, keywords = {Adaptation, Psychological, Adult, Aged, Depressive Disorder/*diagnosis/psychology, Diagnosis, Computer-Assisted, Female, Heart Diseases/*psychology, Humans, Male, Mental Disorders/*psychology, Middle Aged, Models, Statistical, Otorhinolaryngologic Diseases/*psychology, Personality Assessment/statistics \& numerical data, Personality Inventory/*statistics \& numerical data, Psychometrics/statistics \& numerical data, Questionnaires, Reproducibility of Results, Sick Role}, isbn = {0090-5550 (Print)0090-5550 (Linking)}, author = {Forkmann, T. and Boecker, M. and Norra, C. and Eberle, N. and Kircher, T. and Schauerte, P. and Mischke, K. and Westhofen, M. and Gauggel, S. and Wirtz, M.} } @article {227, title = {An evaluation of patient-reported outcomes found computerized adaptive testing was efficient in assessing stress perception}, journal = {Journal of Clinical Epidemiology}, volume = {62}, number = {3}, year = {2009}, note = {Kocalevent, Ruya-DanielaRose, MatthiasBecker, JanineWalter, Otto BFliege, HerbertBjorner, Jakob BKleiber, DieterKlapp, Burghard FEvaluation StudiesUnited StatesJournal of clinical epidemiologyJ Clin Epidemiol. 2009 Mar;62(3):278-87, 287.e1-3. Epub 2008 Jul 18.}, pages = {278-287}, edition = {2008/07/22}, abstract = {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.}, 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}, isbn = {1878-5921 (Electronic)0895-4356 (Linking)}, author = {Kocalevent, R. D. and Rose, M. and Becker, J. and Walter, O. B. and Fliege, H. and Bjorner, J. B. and Kleiber, D. and Klapp, B. F.} } @article {330, title = {Item response theory and clinical measurement}, journal = {Annual Review of Clinical Psychology}, volume = {5}, year = {2009}, note = {Reise, Steven PWaller, Niels GU01 AR 52177/AR/NIAMS NIH HHS/United StatesResearch Support, N.I.H., ExtramuralReviewUnited StatesAnnual review of clinical psychologyAnnu Rev Clin Psychol. 2009;5:27-48.}, pages = {27-48}, edition = {2008/11/04}, abstract = {In this review, we examine studies that use item response theory (IRT) to explore the psychometric properties of clinical measures. Next, we consider how IRT has been used in clinical research for: scale linking, computerized adaptive testing, and differential item functioning analysis. Finally, we consider the scale properties of IRT trait scores. We conclude that there are notable differences between cognitive and clinical measures that have relevance for IRT modeling. Future research should be directed toward a better understanding of the metric of the latent trait and the psychological processes that lead to individual differences in item response behaviors.}, keywords = {*Psychological Theory, Humans, Mental Disorders/diagnosis/psychology, Psychological Tests, Psychometrics, Quality of Life, Questionnaires}, isbn = {1548-5951 (Electronic)}, author = {Reise, S. P. and Waller, N. G.} } @article {77, title = {The maximum priority index method for severely constrained item selection in computerized adaptive testing}, journal = {British Journal of Mathematical and Statistical Psychology}, volume = {62}, number = {2}, year = {2009}, note = {Cheng, YingChang, Hua-HuaResearch Support, Non-U.S. Gov{\textquoteright}tEnglandThe British journal of mathematical and statistical psychologyBr J Math Stat Psychol. 2009 May;62(Pt 2):369-83. Epub 2008 Jun 2.}, month = {May}, pages = {369-83}, edition = {2008/06/07}, abstract = {This paper introduces a new heuristic approach, the maximum priority index (MPI) method, for severely constrained item selection in computerized adaptive testing. Our simulation study shows that it is able to accommodate various non-statistical constraints simultaneously, such as content balancing, exposure control, answer key balancing, and so on. Compared with the weighted deviation modelling method, it leads to fewer constraint violations and better exposure control while maintaining the same level of measurement precision.}, keywords = {Aptitude Tests/*statistics \& numerical data, Diagnosis, Computer-Assisted/*statistics \& numerical data, Educational Measurement/*statistics \& numerical data, Humans, Mathematical Computing, Models, Statistical, Personality Tests/*statistics \& numerical data, Psychometrics/*statistics \& numerical data, Reproducibility of Results, Software}, isbn = {0007-1102 (Print)0007-1102 (Linking)}, author = {Cheng, Y and Chang, Hua-Hua} } @article {170, title = {Measuring global physical health in children with cerebral palsy: Illustration of a multidimensional bi-factor model and computerized adaptive testing}, journal = {Quality of Life Research}, volume = {18}, number = {3}, year = {2009}, note = {Haley, Stephen MNi, PengshengDumas, Helene MFragala-Pinkham, Maria AHambleton, Ronald KMontpetit, KathleenBilodeau, NathalieGorton, George EWatson, KyleTucker, Carole AK02 HD045354-01A1/HD/NICHD NIH HHS/United StatesK02 HD45354-01A1/HD/NICHD NIH HHS/United StatesResearch Support, N.I.H., ExtramuralResearch Support, Non-U.S. Gov{\textquoteright}tNetherlandsQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitationQual Life Res. 2009 Apr;18(3):359-70. Epub 2009 Feb 17.}, month = {Apr}, pages = {359-370}, edition = {2009/02/18}, abstract = {PURPOSE: The purposes of this study were to apply a bi-factor model for the determination of test dimensionality and a multidimensional CAT using computer simulations of real data for the assessment of a new global physical health measure for children with cerebral palsy (CP). METHODS: Parent respondents of 306 children with cerebral palsy were recruited from four pediatric rehabilitation hospitals and outpatient clinics. We compared confirmatory factor analysis results across four models: (1) one-factor unidimensional; (2) two-factor multidimensional (MIRT); (3) bi-factor MIRT with fixed slopes; and (4) bi-factor MIRT with varied slopes. We tested whether the general and content (fatigue and pain) person score estimates could discriminate across severity and types of CP, and whether score estimates from a simulated CAT were similar to estimates based on the total item bank, and whether they correlated as expected with external measures. RESULTS: Confirmatory factor analysis suggested separate pain and fatigue sub-factors; all 37 items were retained in the analyses. From the bi-factor MIRT model with fixed slopes, the full item bank scores discriminated across levels of severity and types of CP, and compared favorably to external instruments. CAT scores based on 10- and 15-item versions accurately captured the global physical health scores. CONCLUSIONS: The bi-factor MIRT CAT application, especially the 10- and 15-item versions, yielded accurate global physical health scores that discriminated across known severity groups and types of CP, and correlated as expected with concurrent measures. The CATs have potential for collecting complex data on the physical health of children with CP in an efficient manner.}, keywords = {*Computer Simulation, *Health Status, *Models, Statistical, Adaptation, Psychological, Adolescent, Cerebral Palsy/*physiopathology, Child, Child, Preschool, Factor Analysis, Statistical, Female, Humans, Male, Massachusetts, Pennsylvania, Questionnaires, Young Adult}, isbn = {0962-9343 (Print)0962-9343 (Linking)}, author = {Haley, S. M. and Ni, P. and Dumas, H. M. and Fragala-Pinkham, M. A. and Hambleton, R. K. and Montpetit, K. and Bilodeau, N. and Gorton, G. E. and Watson, K. and Tucker, C. A.} } @article {143, title = {Progress in assessing physical function in arthritis: PROMIS short forms and computerized adaptive testing}, journal = {Journal of Rheumatology}, volume = {36}, number = {9}, year = {2009}, note = {Fries, James FCella, DavidRose, MatthiasKrishnan, EswarBruce, BonnieU01 AR052158/AR/NIAMS NIH HHS/United StatesU01 AR52177/AR/NIAMS NIH HHS/United StatesConsensus Development ConferenceResearch Support, N.I.H., ExtramuralCanadaThe Journal of rheumatologyJ Rheumatol. 2009 Sep;36(9):2061-6.}, month = {Sep}, pages = {2061-2066}, edition = {2009/09/10}, abstract = {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.}, keywords = {*Disability Evaluation, *Outcome Assessment (Health Care), Arthritis/diagnosis/*physiopathology, Health Surveys, Humans, Prognosis, Reproducibility of Results}, isbn = {0315-162X (Print)0315-162X (Linking)}, author = {Fries, J.F. and Cella, D. and Rose, M. and Krishnan, E. and Bruce, B.} } @article {78, title = {Reduction in patient burdens with graphical computerized adaptive testing on the ADL scale: tool development and simulation}, journal = {Health and Quality of Life Outcomes}, volume = {7}, year = {2009}, note = {Chien, Tsair-WeiWu, Hing-ManWang, Weng-ChungCastillo, Roberto VasquezChou, WillyComparative StudyValidation StudiesEnglandHealth and quality of life outcomesHealth Qual Life Outcomes. 2009 May 5;7:39.}, pages = {39}, edition = {2009/05/07}, abstract = {BACKGROUND: The aim of this study was to verify the effectiveness and efficacy of saving time and reducing burden for patients, nurses, and even occupational therapists through computer adaptive testing (CAT). METHODS: Based on an item bank of the Barthel Index (BI) and the Frenchay Activities Index (FAI) for assessing comprehensive activities of daily living (ADL) function in stroke patients, we developed a visual basic application (VBA)-Excel CAT module, and (1) investigated whether the averaged test length via CAT is shorter than that of the traditional all-item-answered non-adaptive testing (NAT) approach through simulation, (2) illustrated the CAT multimedia on a tablet PC showing data collection and response errors of ADL clinical functional measures in stroke patients, and (3) demonstrated the quality control of endorsing scale with fit statistics to detect responding errors, which will be further immediately reconfirmed by technicians once patient ends the CAT assessment. RESULTS: The results show that endorsed items could be shorter on CAT (M = 13.42) than on NAT (M = 23) at 41.64\% efficiency in test length. However, averaged ability estimations reveal insignificant differences between CAT and NAT. CONCLUSION: This study found that mobile nursing services, placed at the bedsides of patients could, through the programmed VBA-Excel CAT module, reduce the burden to patients and save time, more so than the traditional NAT paper-and-pencil testing appraisals.}, keywords = {*Activities of Daily Living, *Computer Graphics, *Computer Simulation, *Diagnosis, Computer-Assisted, Female, Humans, Male, Point-of-Care Systems, Reproducibility of Results, Stroke/*rehabilitation, Taiwan, United States}, isbn = {1477-7525 (Electronic)1477-7525 (Linking)}, author = {Chien, T. W. and Wu, H. M. and Wang, W-C. and Castillo, R. V. and Chou, W.} } @article {173, title = {Replenishing a computerized adaptive test of patient-reported daily activity functioning}, journal = {Quality of Life Research}, volume = {18}, number = {4}, year = {2009}, note = {Haley, Stephen MNi, PengshengJette, Alan MTao, WeiMoed, RichardMeyers, DougLudlow, Larry HK02 HD45354-01/HD/NICHD NIH HHS/United StatesResearch Support, N.I.H., ExtramuralNetherlandsQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitationQual Life Res. 2009 May;18(4):461-71. Epub 2009 Mar 14.}, month = {May}, pages = {461-71}, edition = {2009/03/17}, abstract = {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.}, keywords = {*Activities of Daily Living, *Disability Evaluation, *Questionnaires, *User-Computer Interface, Adult, Aged, Cohort Studies, Computer-Assisted Instruction, Female, Humans, Male, Middle Aged, Outcome Assessment (Health Care)/*methods}, isbn = {0962-9343 (Print)0962-9343 (Linking)}, author = {Haley, S. M. and Ni, P. and Jette, A. M. and Tao, W. and Moed, R. and Meyers, D. and Ludlow, L. H.} } @article {212, title = {Adaptive short forms for outpatient rehabilitation outcome assessment}, journal = {American Journal of Physical Medicine and Rehabilitation}, volume = {87}, number = {10}, year = {2008}, note = {Jette, Alan MHaley, Stephen MNi, PengshengMoed, RichardK02 HD45354-01/HD/NICHD NIH HHS/United StatesR01 HD43568/HD/NICHD NIH HHS/United StatesResearch Support, N.I.H., ExtramuralResearch Support, U.S. Gov{\textquoteright}t, Non-P.H.S.Research Support, U.S. Gov{\textquoteright}t, P.H.S.United StatesAmerican journal of physical medicine \& rehabilitation / Association of Academic PhysiatristsAm J Phys Med Rehabil. 2008 Oct;87(10):842-52.}, month = {Oct}, pages = {842-52}, edition = {2008/09/23}, abstract = {OBJECTIVE: To develop outpatient Adaptive Short Forms for the Activity Measure for Post-Acute Care item bank for use in outpatient therapy settings. DESIGN: A convenience sample of 11,809 adults with spine, lower limb, upper limb, and miscellaneous orthopedic impairments who received outpatient rehabilitation in 1 of 127 outpatient rehabilitation clinics in the United States. We identified optimal items for use in developing outpatient Adaptive Short Forms based on the Basic Mobility and Daily Activities domains of the Activity Measure for Post-Acute Care item bank. Patient scores were derived from the Activity Measure for Post-Acute Care computerized adaptive testing program. Items were selected for inclusion on the Adaptive Short Forms based on functional content, range of item coverage, measurement precision, item exposure rate, and data collection burden. RESULTS: Two outpatient Adaptive Short Forms were developed: (1) an 18-item Basic Mobility Adaptive Short Form and (2) a 15-item Daily Activities Adaptive Short Form, derived from the same item bank used to develop the Activity Measure for Post-Acute Care computerized adaptive testing program. Both Adaptive Short Forms achieved acceptable psychometric properties. CONCLUSIONS: In outpatient postacute care settings where computerized adaptive testing outcome applications are currently not feasible, item response theory-derived Adaptive Short Forms provide the efficient capability to monitor patients{\textquoteright} functional outcomes. The development of Adaptive Short Form functional outcome instruments linked by a common, calibrated item bank has the potential to create a bridge to outcome monitoring across postacute care settings and can facilitate the eventual transformation from Adaptive Short Forms to computerized adaptive testing applications easier and more acceptable to the rehabilitation community.}, keywords = {*Activities of Daily Living, *Ambulatory Care Facilities, *Mobility Limitation, *Treatment Outcome, Disabled Persons/psychology/*rehabilitation, Female, Humans, Male, Middle Aged, Questionnaires, Rehabilitation Centers}, isbn = {1537-7385 (Electronic)}, author = {Jette, A. M. and Haley, S. M. and Ni, P. and Moed, R.} } @article {394, title = {Are we ready for computerized adaptive testing?}, journal = {Psychiatric Services}, volume = {59}, number = {4}, year = {2008}, note = {Unick, George JShumway, MarthaHargreaves, WilliamCommentUnited StatesPsychiatric services (Washington, D.C.)Psychiatr Serv. 2008 Apr;59(4):369.}, month = {Apr}, pages = {369}, edition = {2008/04/02}, keywords = {*Attitude of Health Personnel, *Diagnosis, Computer-Assisted/instrumentation, Humans, Mental Disorders/*diagnosis, Software}, isbn = {1075-2730 (Print)1075-2730 (Linking)}, author = {Unick, G. J. and Shumway, M. and Hargreaves, W.} } @article {88, title = {Assessing self-care and social function using a computer adaptive testing version of the pediatric evaluation of disability inventory}, journal = {Archives of Physical Medicine and Rehabilitation}, volume = {89}, number = {4}, year = {2008}, note = {Coster, Wendy JHaley, Stephen MNi, PengshengDumas, Helene MFragala-Pinkham, Maria AK02 HD45354-01A1/HD/NICHD NIH HHS/United StatesR41 HD052318-01A1/HD/NICHD NIH HHS/United StatesR43 HD42388-01/HD/NICHD NIH HHS/United StatesComparative StudyResearch Support, N.I.H., ExtramuralUnited StatesArchives of physical medicine and rehabilitationArch Phys Med Rehabil. 2008 Apr;89(4):622-9.}, month = {Apr}, pages = {622-629}, edition = {2008/04/01}, abstract = {OBJECTIVE: To examine score agreement, validity, precision, and response burden of a prototype computer adaptive testing (CAT) version of the self-care and social function scales of the Pediatric Evaluation of Disability Inventory compared with the full-length version of these scales. DESIGN: Computer simulation analysis of cross-sectional and longitudinal retrospective data; cross-sectional prospective study. SETTING: Pediatric rehabilitation hospital, including inpatient acute rehabilitation, day school program, outpatient clinics; community-based day care, preschool, and children{\textquoteright}s homes. PARTICIPANTS: Children with disabilities (n=469) and 412 children with no disabilities (analytic sample); 38 children with disabilities and 35 children without disabilities (cross-validation sample). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Summary scores from prototype CAT applications of each scale using 15-, 10-, and 5-item stopping rules; scores from the full-length self-care and social function scales; time (in seconds) to complete assessments and respondent ratings of burden. RESULTS: Scores from both computer simulations and field administration of the prototype CATs were highly consistent with scores from full-length administration (r range, .94-.99). Using computer simulation of retrospective data, discriminant validity, and sensitivity to change of the CATs closely approximated that of the full-length scales, especially when the 15- and 10-item stopping rules were applied. In the cross-validation study the time to administer both CATs was 4 minutes, compared with over 16 minutes to complete the full-length scales. CONCLUSIONS: Self-care and social function score estimates from CAT administration are highly comparable with those obtained from full-length scale administration, with small losses in validity and precision and substantial decreases in administration time.}, keywords = {*Disability Evaluation, *Social Adjustment, Activities of Daily Living, Adolescent, Age Factors, Child, Child, Preschool, Computer Simulation, Cross-Over Studies, Disabled Children/*rehabilitation, Female, Follow-Up Studies, Humans, Infant, Male, Outcome Assessment (Health Care), Reference Values, Reproducibility of Results, Retrospective Studies, Risk Factors, Self Care/*standards/trends, Sex Factors, Sickness Impact Profile}, isbn = {1532-821X (Electronic)0003-9993 (Linking)}, author = {Coster, W. J. and Haley, S. M. and Ni, P. and Dumas, H. M. and Fragala-Pinkham, M. A.} } @article {241, title = {Binary items and beyond: a simulation of computer adaptive testing using the Rasch partial credit model}, journal = {Journal of Applied Measurement}, volume = {9}, number = {1}, year = {2008}, note = {Lange, RenseUnited StatesJournal of applied measurementJ Appl Meas. 2008;9(1):81-104.}, pages = {81-104}, edition = {2008/01/09}, abstract = {Past research on Computer Adaptive Testing (CAT) has focused almost exclusively on the use of binary items and minimizing the number of items to be administrated. To address this situation, extensive computer simulations were performed using partial credit items with two, three, four, and five response categories. Other variables manipulated include the number of available items, the number of respondents used to calibrate the items, and various manipulations of respondents{\textquoteright} true locations. Three item selection strategies were used, and the theoretically optimal Maximum Information method was compared to random item selection and Bayesian Maximum Falsification approaches. The Rasch partial credit model proved to be quite robust to various imperfections, and systematic distortions did occur mainly in the absence of sufficient numbers of items located near the trait or performance levels of interest. The findings further indicate that having small numbers of items is more problematic in practice than having small numbers of respondents to calibrate these items. Most importantly, increasing the number of response categories consistently improved CAT{\textquoteright}s efficiency as well as the general quality of the results. In fact, increasing the number of response categories proved to have a greater positive impact than did the choice of item selection method, as the Maximum Information approach performed only slightly better than the Maximum Falsification approach. Accordingly, issues related to the efficiency of item selection methods are far less important than is commonly suggested in the literature. However, being based on computer simulations only, the preceding presumes that actual respondents behave according to the Rasch model. CAT research could thus benefit from empirical studies aimed at determining whether, and if so, how, selection strategies impact performance.}, keywords = {*Data Interpretation, Statistical, *User-Computer Interface, Educational Measurement/*statistics \& numerical data, Humans, Illinois, Models, Statistical}, isbn = {1529-7713 (Print)1529-7713 (Linking)}, author = {Lange, R.} } @article {273, title = {Combining computer adaptive testing technology with cognitively diagnostic assessment}, journal = {Behavioral Research Methods }, volume = {40}, number = {3}, year = {2008}, note = {McGlohen, MeghanChang, Hua-HuaUnited StatesBehavior research methodsBehav Res Methods. 2008 Aug;40(3):808-21.}, month = {Aug}, pages = {808-21}, edition = {2008/08/14}, abstract = {A major advantage of computerized adaptive testing (CAT) is that it allows the test to home in on an examinee{\textquoteright}s ability level in an interactive manner. The aim of the new area of cognitive diagnosis is to provide information about specific content areas in which an examinee needs help. The goal of this study was to combine the benefit of specific feedback from cognitively diagnostic assessment with the advantages of CAT. In this study, three approaches to combining these were investigated: (1) item selection based on the traditional ability level estimate (theta), (2) item selection based on the attribute mastery feedback provided by cognitively diagnostic assessment (alpha), and (3) item selection based on both the traditional ability level estimate (theta) and the attribute mastery feedback provided by cognitively diagnostic assessment (alpha). The results from these three approaches were compared for theta estimation accuracy, attribute mastery estimation accuracy, and item exposure control. The theta- and alpha-based condition outperformed the alpha-based condition regarding theta estimation, attribute mastery pattern estimation, and item exposure control. Both the theta-based condition and the theta- and alpha-based condition performed similarly with regard to theta estimation, attribute mastery estimation, and item exposure control, but the theta- and alpha-based condition has an additional advantage in that it uses the shadow test method, which allows the administrator to incorporate additional constraints in the item selection process, such as content balancing, item type constraints, and so forth, and also to select items on the basis of both the current theta and alpha estimates, which can be built on top of existing 3PL testing programs.}, keywords = {*Cognition, *Computers, *Models, Statistical, *User-Computer Interface, Diagnosis, Computer-Assisted/*instrumentation, Humans}, isbn = {1554-351X (Print)}, author = {McGlohen, M. and Chang, Hua-Hua} } @article {169, title = {Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: II. Participation outcomes}, journal = {Archives of Physical Medicine and Rehabilitation}, volume = {89}, number = {2}, year = {2008}, note = {Haley, Stephen MGandek, BarbaraSiebens, HilaryBlack-Schaffer, Randie MSinclair, Samuel JTao, WeiCoster, Wendy JNi, PengshengJette, Alan MK02 HD045354-01A1/HD/NICHD NIH HHS/United StatesK02 HD45354-01/HD/NICHD NIH HHS/United StatesR01 HD043568/HD/NICHD NIH HHS/United StatesR01 HD043568-01/HD/NICHD NIH HHS/United StatesResearch Support, N.I.H., ExtramuralUnited StatesArchives of physical medicine and rehabilitationArch Phys Med Rehabil. 2008 Feb;89(2):275-83.}, month = {Feb}, pages = {275-283}, edition = {2008/01/30}, abstract = {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{\textquoteright}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.}, keywords = {*Activities of Daily Living, *Adaptation, Physiological, *Computer Systems, *Questionnaires, Adult, Aged, Aged, 80 and over, Chi-Square Distribution, Factor Analysis, Statistical, Female, Humans, Longitudinal Studies, Male, Middle Aged, Outcome Assessment (Health Care)/*methods, Patient Discharge, Prospective Studies, Rehabilitation/*standards, Subacute Care/*standards}, isbn = {1532-821X (Electronic)0003-9993 (Linking)}, author = {Haley, S. M. and Gandek, B. and Siebens, H. and Black-Schaffer, R. M. and Sinclair, S. J. and Tao, W. and Coster, W. J. and Ni, P. and Jette, A. M.} } @article {231, title = {Computerized adaptive testing in back pain: Validation of the CAT-5D-QOL}, journal = {Spine}, volume = {33}, number = {12}, year = {2008}, note = {Kopec, Jacek ABadii, MaziarMcKenna, MarioLima, Viviane DSayre, Eric CDvorak, MarcelResearch Support, Non-U.S. Gov{\textquoteright}tValidation StudiesUnited StatesSpineSpine (Phila Pa 1976). 2008 May 20;33(12):1384-90.}, month = {May 20}, pages = {1384-90}, edition = {2008/05/23}, abstract = {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.}, keywords = {*Disability Evaluation, *Health Status Indicators, *Quality of Life, Adult, Aged, Algorithms, Back Pain/*diagnosis/psychology, British Columbia, Diagnosis, Computer-Assisted/*standards, Feasibility Studies, Female, Humans, Internet, Male, Middle Aged, Predictive Value of Tests, Questionnaires/*standards, Reproducibility of Results}, isbn = {1528-1159 (Electronic)0362-2436 (Linking)}, author = {Kopec, J. A. and Badii, M. and McKenna, M. and Lima, V. D. and Sayre, E. C. and Dvorak, M.} } @article {73, title = {Controlling item exposure and test overlap on the fly in computerized adaptive testing}, journal = {British Journal of Mathematical and Statistical Psychology}, volume = {61}, number = {2}, year = {2008}, note = {Chen, Shu-YingLei, Pui-WaLiao, Wen-HanResearch Support, Non-U.S. Gov{\textquoteright}tEnglandThe British journal of mathematical and statistical psychologyBr J Math Stat Psychol. 2008 Nov;61(Pt 2):471-92. Epub 2007 Jul 23.}, month = {Nov}, pages = {471-92}, edition = {2007/07/26}, abstract = {This paper proposes an on-line version of the Sympson and Hetter procedure with test overlap control (SHT) that can provide item exposure control at both the item and test levels on the fly without iterative simulations. The on-line procedure is similar to the SHT procedure in that exposure parameters are used for simultaneous control of item exposure rates and test overlap rate. The exposure parameters for the on-line procedure, however, are updated sequentially on the fly, rather than through iterative simulations conducted prior to operational computerized adaptive tests (CATs). Unlike the SHT procedure, the on-line version can control item exposure rate and test overlap rate without time-consuming iterative simulations even when item pools or examinee populations have been changed. Moreover, the on-line procedure was found to perform better than the SHT procedure in controlling item exposure and test overlap for examinees who take tests earlier. Compared with two other on-line alternatives, this proposed on-line method provided the best all-around test security control. Thus, it would be an efficient procedure for controlling item exposure and test overlap in CATs.}, keywords = {*Decision Making, Computer-Assisted, *Models, Psychological, Humans}, isbn = {0007-1102 (Print)0007-1102 (Linking)}, author = {Chen, S-Y. and Lei, P. W. and Liao, W. H.} } @article {5, title = {Efficiency and sensitivity of multidimensional computerized adaptive testing of pediatric physical functioning}, journal = {Disability \& Rehabilitation}, volume = {30}, number = {6}, year = {2008}, note = {Allen, Diane DNi, PengshengHaley, Stephen MK02 HD45354-01/HD/NICHD NIH HHS/United StatesNIDDR H133P0001/DD/NCBDD CDC HHS/United StatesResearch Support, N.I.H., ExtramuralEnglandDisability and rehabilitationDisabil Rehabil. 2008;30(6):479-84.}, pages = {479-84}, edition = {2008/02/26}, abstract = {PURPOSE: Computerized adaptive tests (CATs) have efficiency advantages over fixed-length tests of physical functioning but may lose sensitivity when administering extremely low numbers of items. Multidimensional CATs may efficiently improve sensitivity by capitalizing on correlations between functional domains. Using a series of empirical simulations, we assessed the efficiency and sensitivity of multidimensional CATs compared to a longer fixed-length test. METHOD: Parent responses to the Pediatric Evaluation of Disability Inventory before and after intervention for 239 children at a pediatric rehabilitation hospital provided the data for this retrospective study. Reliability, effect size, and standardized response mean were compared between full-length self-care and mobility subscales and simulated multidimensional CATs with stopping rules at 40, 30, 20, and 10 items. RESULTS: Reliability was lowest in the 10-item CAT condition for the self-care (r = 0.85) and mobility (r = 0.79) subscales; all other conditions had high reliabilities (r > 0.94). All multidimensional CAT conditions had equivalent levels of sensitivity compared to the full set condition for both domains. CONCLUSIONS: Multidimensional CATs efficiently retain the sensitivity of longer fixed-length measures even with 5 items per dimension (10-item CAT condition). Measuring physical functioning with multidimensional CATs could enhance sensitivity following intervention while minimizing response burden.}, keywords = {*Disability Evaluation, Child, Computers, Disabled Children/*classification/rehabilitation, Efficiency, Humans, Outcome Assessment (Health Care), Psychometrics, Reproducibility of Results, Retrospective Studies, Self Care, Sensitivity and Specificity}, isbn = {0963-8288 (Print)0963-8288 (Linking)}, author = {Allen, D. D. and Ni, P. and Haley, S. M.} } @article {84, title = {Letting the CAT out of the bag: Comparing computer adaptive tests and an 11-item short form of the Roland-Morris Disability Questionnaire}, journal = {Spine}, volume = {33}, number = {12}, year = {2008}, note = {Cook, Karon FChoi, Seung WCrane, Paul KDeyo, Richard AJohnson, Kurt LAmtmann, Dagmar5 P60-AR48093/AR/United States NIAMS5U01AR052171-03/AR/United States NIAMSComparative StudyResearch Support, N.I.H., ExtramuralUnited StatesSpineSpine. 2008 May 20;33(12):1378-83.}, month = {May 20}, pages = {1378-83}, edition = {2008/05/23}, abstract = {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{\textquoteright}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.}, keywords = {*Disability Evaluation, *Health Status Indicators, Adult, Aged, Aged, 80 and over, Back Pain/*diagnosis/psychology, Calibration, Computer Simulation, Diagnosis, Computer-Assisted/*standards, Humans, Middle Aged, Models, Psychological, Predictive Value of Tests, Questionnaires/*standards, Reproducibility of Results}, isbn = {1528-1159 (Electronic)}, author = {Cook, K. F. and Choi, S. W. and Crane, P. K. and Deyo, R. A. and Johnson, K. L. and Amtmann, D.} } @article {287, title = {Measuring physical functioning in children with spinal impairments with computerized adaptive testing}, journal = {Journal of Pediatric Orthopedics}, volume = {28}, number = {3}, year = {2008}, note = {Mulcahey, M JHaley, Stephen MDuffy, TheresaPengsheng, NiBetz, Randal RK02 HD045354-01A1/HD/NICHD NIH HHS/United StatesUnited StatesJournal of pediatric orthopedicsJ Pediatr Orthop. 2008 Apr-May;28(3):330-5.}, month = {Apr-May}, pages = {330-5}, edition = {2008/03/26}, abstract = {BACKGROUND: The purpose of this study was to assess the utility of measuring current physical functioning status of children with scoliosis and kyphosis by applying computerized adaptive testing (CAT) methods. Computerized adaptive testing uses a computer interface to administer the most optimal items based on previous responses, reducing the number of items needed to obtain a scoring estimate. METHODS: This was a prospective study of 77 subjects (0.6-19.8 years) who were seen by a spine surgeon during a routine clinic visit for progress spine deformity. Using a multidimensional version of the Pediatric Evaluation of Disability Inventory CAT program (PEDI-MCAT), we evaluated content range, accuracy and efficiency, known-group validity, concurrent validity with the Pediatric Outcomes Data Collection Instrument, and test-retest reliability in a subsample (n = 16) within a 2-week interval. RESULTS: We found the PEDI-MCAT to have sufficient item coverage in both self-care and mobility content for this sample, although most patients tended to score at the higher ends of both scales. Both the accuracy of PEDI-MCAT scores as compared with a fixed format of the PEDI (r = 0.98 for both mobility and self-care) and test-retest reliability were very high [self-care: intraclass correlation (3,1) = 0.98, mobility: intraclass correlation (3,1) = 0.99]. The PEDI-MCAT took an average of 2.9 minutes for the parents to complete. The PEDI-MCAT detected expected differences between patient groups, and scores on the PEDI-MCAT correlated in expected directions with scores from the Pediatric Outcomes Data Collection Instrument domains. CONCLUSIONS: Use of the PEDI-MCAT to assess the physical functioning status, as perceived by parents of children with complex spinal impairments, seems to be feasible and achieves accurate and efficient estimates of self-care and mobility function. Additional item development will be needed at the higher functioning end of the scale to avoid ceiling effects for older children. LEVEL OF EVIDENCE: This is a level II prospective study designed to establish the utility of computer adaptive testing as an evaluation method in a busy pediatric spine practice.}, keywords = {*Disability Evaluation, Adolescent, Child, Child, Preschool, Computer Simulation, Cross-Sectional Studies, Disabled Children/*rehabilitation, Female, Humans, Infant, Kyphosis/*diagnosis/rehabilitation, Male, Prospective Studies, Reproducibility of Results, Scoliosis/*diagnosis/rehabilitation}, isbn = {0271-6798 (Print)0271-6798 (Linking)}, author = {Mulcahey, M. J. and Haley, S. M. and Duffy, T. and Pengsheng, N. and Betz, R. R.} } @article {293, title = {The NAPLEX: evolution, purpose, scope, and educational implications}, journal = {American Journal of Pharmaceutical Education}, volume = {72}, number = {2}, year = {2008}, note = {Newton, David WBoyle, MariaCatizone, Carmen AHistorical ArticleUnited StatesAmerican journal of pharmaceutical educationAm J Pharm Educ. 2008 Apr 15;72(2):33.}, month = {Apr 15}, pages = {33}, edition = {2008/05/17}, abstract = {Since 2004, passing the North American Pharmacist Licensure Examination (NAPLEX) has been a requirement for earning initial pharmacy licensure in all 50 United States. The creation and evolution from 1952-2005 of the particular pharmacy competency testing areas and quantities of questions are described for the former paper-and-pencil National Association of Boards of Pharmacy Licensure Examination (NABPLEX) and the current candidate-specific computer adaptive NAPLEX pharmacy licensure examinations. A 40\% increase in the weighting of NAPLEX Blueprint Area 2 in May 2005, compared to that in the preceding 1997-2005 Blueprint, has implications for candidates{\textquoteright} NAPLEX performance and associated curricular content and instruction. New pharmacy graduates{\textquoteright} scores on the NAPLEX are neither intended nor validated to serve as a criterion for assessing or judging the quality or effectiveness of pharmacy curricula and instruction. The newest cycle of NAPLEX Blueprint revision, a continual process to ensure representation of nationwide contemporary practice, began in early 2008. It may take up to 2 years, including surveying several thousand national pharmacists, to complete.}, keywords = {*Educational Measurement, Education, Pharmacy/*standards, History, 20th Century, History, 21st Century, Humans, Licensure, Pharmacy/history/*legislation \& jurisprudence, North America, Pharmacists/*legislation \& jurisprudence, Software}, isbn = {1553-6467 (Electronic)0002-9459 (Linking)}, author = {Newton, D. W. and Boyle, M. and Catizone, C. A.} } @article {71, title = {Predicting item exposure parameters in computerized adaptive testing}, journal = {British Journal of Mathematical and Statistical Psychology}, volume = {61}, number = {1}, year = {2008}, note = {Chen, Shu-YingDoong, Shing-HwangResearch Support, Non-U.S. Gov{\textquoteright}tEnglandThe British journal of mathematical and statistical psychologyBr J Math Stat Psychol. 2008 May;61(Pt 1):75-91.}, month = {May}, pages = {75-91}, edition = {2008/05/17}, abstract = {The purpose of this study is to find a formula that describes the relationship between item exposure parameters and item parameters in computerized adaptive tests by using genetic programming (GP) - a biologically inspired artificial intelligence technique. Based on the formula, item exposure parameters for new parallel item pools can be predicted without conducting additional iterative simulations. Results show that an interesting formula between item exposure parameters and item parameters in a pool can be found by using GP. The item exposure parameters predicted based on the found formula were close to those observed from the Sympson and Hetter (1985) procedure and performed well in controlling item exposure rates. Similar results were observed for the Stocking and Lewis (1998) multinomial model for item selection and the Sympson and Hetter procedure with content balancing. The proposed GP approach has provided a knowledge-based solution for finding item exposure parameters.}, keywords = {*Algorithms, *Artificial Intelligence, Aptitude Tests/*statistics \& numerical data, Diagnosis, Computer-Assisted/*statistics \& numerical data, Humans, Models, Statistical, Psychometrics/statistics \& numerical data, Reproducibility of Results, Software}, isbn = {0007-1102 (Print)0007-1102 (Linking)}, author = {Chen, S-Y. and Doong, S. H.} } @article {17, title = {Rotating item banks versus restriction of maximum exposure rates in computerized adaptive testing}, journal = {Spanish Journal of Psychology}, volume = {11}, number = {2}, year = {2008}, note = {Barrada, Juan RamonOlea, JulioAbad, Francisco JoseResearch Support, Non-U.S. Gov{\textquoteright}tSpainThe Spanish journal of psychologySpan J Psychol. 2008 Nov;11(2):618-25.}, pages = {618-625}, edition = {2008/11/08}, abstract = {

If examinees were to know, beforehand, part of the content of a computerized adaptive test, their estimated trait levels would then have a marked positive bias. One of the strategies to avoid this consists of dividing a large item bank into several sub-banks and rotating the sub-bank employed (Ariel, Veldkamp \& van der Linden, 2004). This strategy permits substantial improvements in exposure control at little cost to measurement accuracy, However, we do not know whether this option provides better results than using the master bank with greater restriction in the maximum exposure rates (Sympson \& Hetter, 1985). In order to investigate this issue, we worked with several simulated banks of 2100 items, comparing them, for RMSE and overlap rate, with the same banks divided in two, three... up to seven sub-banks. By means of extensive manipulation of the maximum exposure rate in each bank, we found that the option of rotating banks slightly outperformed the option of restricting maximum exposure rate of the master bank by means of the Sympson-Hetter method.

}, keywords = {*Character, *Databases, *Software Design, Aptitude Tests/*statistics \& numerical data, Bias (Epidemiology), Computing Methodologies, Diagnosis, Computer-Assisted/*statistics \& numerical data, Educational Measurement/*statistics \& numerical data, Humans, Mathematical Computing, Psychometrics/statistics \& numerical data}, isbn = {1138-7416}, author = {Barrada, J and Olea, J. and Abad, F. J.} } @article {95, title = {Strategies for controlling item exposure in computerized adaptive testing with the partial credit model}, journal = {Journal of Applied Measurement}, volume = {9}, number = {1}, year = {2008}, note = {Davis, Laurie LaughlinDodd, Barbara GUnited StatesJournal of applied measurementJ Appl Meas. 2008;9(1):1-17.}, pages = {1-17}, edition = {2008/01/09}, abstract = {Exposure control research with polytomous item pools has determined that randomization procedures can be very effective for controlling test security in computerized adaptive testing (CAT). The current study investigated the performance of four procedures for controlling item exposure in a CAT under the partial credit model. In addition to a no exposure control baseline condition, the Kingsbury-Zara, modified-within-.10-logits, Sympson-Hetter, and conditional Sympson-Hetter procedures were implemented to control exposure rates. The Kingsbury-Zara and the modified-within-.10-logits procedures were implemented with 3 and 6 item candidate conditions. The results show that the Kingsbury-Zara and modified-within-.10-logits procedures with 6 item candidates performed as well as the conditional Sympson-Hetter in terms of exposure rates, overlap rates, and pool utilization. These two procedures are strongly recommended for use with partial credit CATs due to their simplicity and strength of their results.}, keywords = {*Algorithms, *Computers, *Educational Measurement/statistics \& numerical data, Humans, Questionnaires/*standards, United States}, isbn = {1529-7713 (Print)1529-7713 (Linking)}, author = {Davis, L. L. and Dodd, B. G.} } @article {152, title = {Using computerized adaptive testing to reduce the burden of mental health assessment}, journal = {Psychiatric Services}, volume = {59}, number = {4}, year = {2008}, note = {Gibbons, Robert DWeiss, David JKupfer, David JFrank, EllenFagiolini, AndreaGrochocinski, Victoria JBhaumik, Dulal KStover, AngelaBock, R DarrellImmekus, Jason CR01-MH-30915/MH/United States NIMHR01-MH-66302/MH/United States NIMHResearch Support, N.I.H., ExtramuralUnited StatesPsychiatric services (Washington, D.C.)Psychiatr Serv. 2008 Apr;59(4):361-8.}, month = {Apr}, pages = {361-8}, edition = {2008/04/02}, abstract = {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{\textquoteright}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.}, keywords = {*Diagnosis, Computer-Assisted, *Questionnaires, Adolescent, Adult, Aged, Agoraphobia/diagnosis, Anxiety Disorders/diagnosis, Bipolar Disorder/diagnosis, Female, Humans, Male, Mental Disorders/*diagnosis, Middle Aged, Mood Disorders/diagnosis, Obsessive-Compulsive Disorder/diagnosis, Panic Disorder/diagnosis, Phobic Disorders/diagnosis, Reproducibility of Results, Time Factors}, isbn = {1075-2730 (Print)}, author = {Gibbons, R. D. and Weiss, D. J. and Kupfer, D. J. and Frank, E. and Fagiolini, A. and Grochocinski, V. J. and Bhaumik, D. K. and Stover, A. and Bock, R. D. and Immekus, J. C.} } @article {135, title = {Computerized adaptive personality testing: A review and illustration with the MMPI-2 Computerized Adaptive Version}, journal = {Psychological Assessment}, volume = {19}, number = {1}, year = {2007}, note = {Forbey, Johnathan DBen-Porath, Yossef SResearch Support, Non-U.S. Gov{\textquoteright}tUnited StatesPsychological assessmentPsychol Assess. 2007 Mar;19(1):14-24.}, month = {Mar}, pages = {14-24}, edition = {2007/03/21}, abstract = {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.}, keywords = {Adolescent, Adult, Diagnosis, Computer-Assisted/*statistics \& numerical data, Female, Humans, Male, MMPI/*statistics \& numerical data, Personality Assessment/*statistics \& numerical data, Psychometrics/statistics \& numerical data, Reference Values, Reproducibility of Results}, isbn = {1040-3590 (Print)}, author = {Forbey, J. D. and Ben-Porath, Y. S.} } @article {210, title = {Computerized adaptive testing for measuring development of young children}, journal = {Statistics in Medicine}, volume = {26}, number = {13}, year = {2007}, note = {Jacobusse, GertBuuren, Stef vanEnglandStatistics in medicineStat Med. 2007 Jun 15;26(13):2629-38.}, month = {Jun 15}, pages = {2629-38}, edition = {2006/11/30}, abstract = {Developmental indicators that are used for routine measurement in The Netherlands are usually chosen to optimally identify delayed children. Measurements on the majority of children without problems are therefore quite imprecise. This study explores the use of computerized adaptive testing (CAT) to monitor the development of young children. CAT is expected to improve the measurement precision of the instrument. We do two simulation studies - one with real data and one with simulated data - to evaluate the usefulness of CAT. It is shown that CAT selects developmental indicators that maximally match the individual child, so that all children can be measured to the same precision.}, keywords = {*Child Development, *Models, Statistical, Child, Preschool, Diagnosis, Computer-Assisted/*statistics \& numerical data, Humans, Netherlands}, isbn = {0277-6715 (Print)}, author = {Jacobusse, G. and Buuren, S.} } @article {29, title = {Developing tailored instruments: item banking and computerized adaptive assessment}, journal = {Quality of Life Research}, volume = {16}, number = {Suppl 1}, year = {2007}, note = {Bjorner, Jakob BueChang, Chih-HungThissen, DavidReeve, Bryce B1R43NS047763-01/NS/United States NINDSAG015815/AG/United States NIAResearch Support, N.I.H., ExtramuralNetherlandsQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitationQual Life Res. 2007;16 Suppl 1:95-108. Epub 2007 Feb 15.}, pages = {95-108}, edition = {2007/05/29}, abstract = {Item banks and Computerized Adaptive Testing (CAT) have the potential to greatly improve the assessment of health outcomes. This review describes the unique features of item banks and CAT and discusses how to develop item banks. In CAT, a computer selects the items from an item bank that are most relevant for and informative about the particular respondent; thus optimizing test relevance and precision. Item response theory (IRT) provides the foundation for selecting the items that are most informative for the particular respondent and for scoring responses on a common metric. The development of an item bank is a multi-stage process that requires a clear definition of the construct to be measured, good items, a careful psychometric analysis of the items, and a clear specification of the final CAT. The psychometric analysis needs to evaluate the assumptions of the IRT model such as unidimensionality and local independence; that the items function the same way in different subgroups of the population; and that there is an adequate fit between the data and the chosen item response models. Also, interpretation guidelines need to be established to help the clinical application of the assessment. Although medical research can draw upon expertise from educational testing in the development of item banks and CAT, the medical field also encounters unique opportunities and challenges.}, keywords = {*Health Status, *Health Status Indicators, *Mental Health, *Outcome Assessment (Health Care), *Quality of Life, *Questionnaires, *Software, Algorithms, Factor Analysis, Statistical, Humans, Models, Statistical, Psychometrics}, isbn = {0962-9343 (Print)}, author = {Bjorner, J. B. and Chang, C-H. and Thissen, D. and Reeve, B. B.} } @article {52, title = {Improving patient reported outcomes using item response theory and computerized adaptive testing}, journal = {Journal of Rheumatology}, volume = {34}, number = {6}, year = {2007}, note = {Chakravarty, Eliza FBjorner, Jakob BFries, James FAr052158/ar/niamsConsensus Development ConferenceResearch Support, N.I.H., ExtramuralCanadaThe Journal of rheumatologyJ Rheumatol. 2007 Jun;34(6):1426-31.}, month = {Jun}, pages = {1426-31}, edition = {2007/06/07}, abstract = {OBJECTIVE: Patient reported outcomes (PRO) are considered central outcome measures for both clinical trials and observational studies in rheumatology. More sophisticated statistical models, including item response theory (IRT) and computerized adaptive testing (CAT), will enable critical evaluation and reconstruction of currently utilized PRO instruments to improve measurement precision while reducing item burden on the individual patient. METHODS: We developed a domain hierarchy encompassing the latent trait of physical function/disability from the more general to most specific. Items collected from 165 English-language instruments were evaluated by a structured process including trained raters, modified Delphi expert consensus, and then patient evaluation. Each item in the refined data bank will undergo extensive analysis using IRT to evaluate response functions and measurement precision. CAT will allow for real-time questionnaires of potentially smaller numbers of questions tailored directly to each individual{\textquoteright}s level of physical function. RESULTS: Physical function/disability domain comprises 4 subdomains: upper extremity, trunk, lower extremity, and complex activities. Expert and patient review led to consensus favoring use of present-tense "capability" questions using a 4- or 5-item Likert response construct over past-tense "performance"items. Floor and ceiling effects, attribution of disability, and standardization of response categories were also addressed. CONCLUSION: By applying statistical techniques of IRT through use of CAT, existing PRO instruments may be improved to reduce questionnaire burden on the individual patients while increasing measurement precision that may ultimately lead to reduced sample size requirements for costly clinical trials.}, keywords = {*Rheumatic Diseases/physiopathology/psychology, Clinical Trials, Data Interpretation, Statistical, Disability Evaluation, Health Surveys, Humans, International Cooperation, Outcome Assessment (Health Care)/*methods, Patient Participation/*methods, Research Design/*trends, Software}, isbn = {0315-162X (Print)}, author = {Chakravarty, E. F. and Bjorner, J. B. and Fries, J.F.} } @article {86, title = {IRT health outcomes data analysis project: an overview and summary}, journal = {Quality of Life Research}, volume = {16}, number = {Suppl. 1}, year = {2007}, note = {Cook, Karon FTeal, Cayla RBjorner, Jakob BCella, DavidChang, Chih-HungCrane, Paul KGibbons, Laura EHays, Ron DMcHorney, Colleen AOcepek-Welikson, KatjaRaczek, Anastasia ETeresi, Jeanne AReeve, Bryce B1U01AR52171-01/AR/United States NIAMSR01 (CA60068)/CA/United States NCIY1-PC-3028-01/PC/United States NCIResearch Support, N.I.H., ExtramuralNetherlandsQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitationQual Life Res. 2007;16 Suppl 1:121-32. Epub 2007 Mar 10.}, pages = {121-132}, edition = {2007/03/14}, abstract = {BACKGROUND: In June 2004, the National Cancer Institute and the Drug Information Association co-sponsored the conference, "Improving the Measurement of Health Outcomes through the Applications of Item Response Theory (IRT) Modeling: Exploration of Item Banks and Computer-Adaptive Assessment." A component of the conference was presentation of a psychometric and content analysis of a secondary dataset. OBJECTIVES: A thorough psychometric and content analysis was conducted of two primary domains within a cancer health-related quality of life (HRQOL) dataset. RESEARCH DESIGN: HRQOL scales were evaluated using factor analysis for categorical data, IRT modeling, and differential item functioning analyses. In addition, computerized adaptive administration of HRQOL item banks was simulated, and various IRT models were applied and compared. SUBJECTS: The original data were collected as part of the NCI-funded Quality of Life Evaluation in Oncology (Q-Score) Project. A total of 1,714 patients with cancer or HIV/AIDS were recruited from 5 clinical sites. MEASURES: Items from 4 HRQOL instruments were evaluated: Cancer Rehabilitation Evaluation System-Short Form, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Functional Assessment of Cancer Therapy and Medical Outcomes Study Short-Form Health Survey. RESULTS AND CONCLUSIONS: Four lessons learned from the project are discussed: the importance of good developmental item banks, the ambiguity of model fit results, the limits of our knowledge regarding the practical implications of model misfit, and the importance in the measurement of HRQOL of construct definition. With respect to these lessons, areas for future research are suggested. The feasibility of developing item banks for broad definitions of health is discussed.}, keywords = {*Data Interpretation, Statistical, *Health Status, *Quality of Life, *Questionnaires, *Software, Female, HIV Infections/psychology, Humans, Male, Neoplasms/psychology, Outcome Assessment (Health Care)/*methods, Psychometrics, Stress, Psychological}, isbn = {0962-9343 (Print)}, author = {Cook, K. F. and Teal, C. R. and Bjorner, J. B. and Cella, D. and Chang, C-H. and Crane, P. K. and Gibbons, L. E. and Hays, R. D. and McHorney, C. A. and Ocepek-Welikson, K. and Raczek, A. E. and Teresi, J. A. and Reeve, B. B.} } @article {53, title = {Patient-reported outcomes measurement and management with innovative methodologies and technologies}, journal = {Quality of Life Research}, volume = {16 Suppl 1}, year = {2007}, note = {Chang, Chih-HungR21CA113191/CA/NCI NIH HHS/United StatesResearch Support, N.I.H., ExtramuralNetherlandsQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitationQual Life Res. 2007;16 Suppl 1:157-66. Epub 2007 May 26.}, pages = {157-66}, edition = {2007/05/29}, abstract = {Successful integration of modern psychometrics and advanced informatics in patient-reported outcomes (PRO) measurement and management can potentially maximize the value of health outcomes research and optimize the delivery of quality patient care. Unlike the traditional labor-intensive paper-and-pencil data collection method, item response theory-based computerized adaptive testing methodologies coupled with novel technologies provide an integrated environment to collect, analyze and present ready-to-use PRO data for informed and shared decision-making. This article describes the needs, challenges and solutions for accurate, efficient and cost-effective PRO data acquisition and dissemination means in order to provide critical and timely PRO information necessary to actively support and enhance routine patient care in busy clinical settings.}, keywords = {*Health Status, *Outcome Assessment (Health Care), *Quality of Life, *Software, Computer Systems/*trends, Health Insurance Portability and Accountability Act, Humans, Patient Satisfaction, Questionnaires, United States}, isbn = {0962-9343 (Print)0962-9343 (Linking)}, author = {Chang, C-H.} } @article {328, title = {Psychometric evaluation and calibration of health-related quality of life item banks: plans for the Patient-Reported Outcomes Measurement Information System (PROMIS)}, journal = {Medical Care}, volume = {45}, number = {5 Suppl 1}, year = {2007}, note = {Reeve, Bryce BHays, Ron DBjorner, Jakob BCook, Karon FCrane, Paul KTeresi, Jeanne AThissen, DavidRevicki, Dennis AWeiss, David JHambleton, Ronald KLiu, HonghuGershon, RichardReise, Steven PLai, Jin-sheiCella, DavidPROMIS Cooperative GroupAG015815/AG/United States NIAResearch Support, N.I.H., ExtramuralUnited StatesMedical careMed Care. 2007 May;45(5 Suppl 1):S22-31.}, month = {May}, pages = {S22-31}, edition = {2007/04/20}, abstract = {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.}, keywords = {*Health Status, *Information Systems, *Quality of Life, *Self Disclosure, Adolescent, Adult, Aged, Calibration, Databases as Topic, Evaluation Studies as Topic, Female, Humans, Male, Middle Aged, Outcome Assessment (Health Care)/*methods, Psychometrics, Questionnaires/standards, United States}, isbn = {0025-7079 (Print)}, author = {Reeve, B. B. and Hays, R. D. and Bjorner, J. B. and Cook, K. F. and Crane, P. K. and Teresi, J. A. and Thissen, D. and Revicki, D. A. and Weiss, D. J. and Hambleton, R. K. and Liu, H. and Gershon, R. C. and Reise, S. P. and Lai, J. S. and Cella, D.} } @article {54, title = {A system for interactive assessment and management in palliative care}, journal = {Journal of Pain Symptom Management}, volume = {33}, number = {6}, year = {2007}, note = {Chang, Chih-HungBoni-Saenz, Alexander ADurazo-Arvizu, Ramon ADesHarnais, SusanLau, Denys TEmanuel, Linda LR21CA113191/CA/United States NCIResearch Support, N.I.H., ExtramuralReviewUnited StatesJournal of pain and symptom managementJ Pain Symptom Manage. 2007 Jun;33(6):745-55. Epub 2007 Mar 23.}, pages = {745-55}, edition = {2007/03/16}, abstract = {The availability of psychometrically sound and clinically relevant screening, diagnosis, and outcome evaluation tools is essential to high-quality palliative care assessment and management. Such data will enable us to improve patient evaluations, prognoses, and treatment selections, and to increase patient satisfaction and quality of life. To accomplish these goals, medical care needs more precise, efficient, and comprehensive tools for data acquisition, analysis, interpretation, and management. We describe a system for interactive assessment and management in palliative care (SIAM-PC), which is patient centered, model driven, database derived, evidence based, and technology assisted. The SIAM-PC is designed to reliably measure the multiple dimensions of patients{\textquoteright} needs for palliative care, and then to provide information to clinicians, patients, and the patients{\textquoteright} families to achieve optimal patient care, while improving our capacity for doing palliative care research. This system is innovative in its application of the state-of-the-science approaches, such as item response theory and computerized adaptive testing, to many of the significant clinical problems related to palliative care.}, keywords = {*Needs Assessment, Humans, Medical Informatics/*organization \& administration, Palliative Care/*organization \& administration}, isbn = {0885-3924 (Print)}, author = {Chang, C-H. and Boni-Saenz, A. A. and Durazo-Arvizu, R. A. and DesHarnais, S. and Lau, D. T. and Emanuel, L. L.} } @article {172, title = {Computer adaptive testing improved accuracy and precision of scores over random item selection in a physical functioning item bank}, journal = {Journal of Clinical Epidemiology}, volume = {59}, number = {11}, year = {2006}, note = {Haley, Stephen MNi, PengshengHambleton, Ronald KSlavin, Mary DJette, Alan MK02 hd45354-01/hd/nichdR01 hd043568/hd/nichdComparative StudyResearch Support, N.I.H., ExtramuralResearch Support, U.S. Gov{\textquoteright}t, Non-P.H.S.EnglandJournal of clinical epidemiologyJ Clin Epidemiol. 2006 Nov;59(11):1174-82. Epub 2006 Jul 11.}, month = {Nov}, pages = {1174-82}, edition = {2006/10/10}, abstract = {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.}, keywords = {*Recovery of Function, Activities of Daily Living, Adolescent, Adult, Aged, Aged, 80 and over, Confidence Intervals, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Outcome Assessment (Health Care)/*methods, Rehabilitation/*standards, Reproducibility of Results, Software}, isbn = {0895-4356 (Print)}, author = {Haley, S. M. and Ni, P. and Hambleton, R. K. and Slavin, M. D. and Jette, A. M.} } @article {176, title = {Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: I. Activity outcomes}, journal = {Archives of Physical Medicine and Rehabilitation}, volume = {87}, number = {8}, year = {2006}, note = {Haley, Stephen MSiebens, HilaryCoster, Wendy JTao, WeiBlack-Schaffer, Randie MGandek, BarbaraSinclair, Samuel JNi, PengshengK0245354-01/phsR01 hd043568/hd/nichdResearch Support, N.I.H., ExtramuralUnited StatesArchives of physical medicine and rehabilitationArch Phys Med Rehabil. 2006 Aug;87(8):1033-42.}, month = {Aug}, pages = {1033-42}, edition = {2006/08/01}, abstract = {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{\textquoteright} 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{\textquoteright} 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.}, keywords = {*Activities of Daily Living, *Adaptation, Physiological, *Computer Systems, *Questionnaires, Adult, Aged, Aged, 80 and over, Chi-Square Distribution, Factor Analysis, Statistical, Female, Humans, Longitudinal Studies, Male, Middle Aged, Outcome Assessment (Health Care)/*methods, Patient Discharge, Prospective Studies, Rehabilitation/*standards, Subacute Care/*standards}, isbn = {0003-9993 (Print)}, author = {Haley, S. M. and Siebens, H. and Coster, W. J. and Tao, W. and Black-Schaffer, R. M. and Gandek, B. and Sinclair, S. J. and Ni, P.} } @article {352, title = {Computerized adaptive testing of diabetes impact: a feasibility study of Hispanics and non-Hispanics in an active clinic population}, journal = {Quality of Life Research}, volume = {15}, number = {9}, year = {2006}, note = {Schwartz, CarolynWelch, GarrySantiago-Kelley, PaulaBode, RitaSun, Xiaowu1 r43 dk066874-01/dk/niddkResearch Support, N.I.H., ExtramuralNetherlandsQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitationQual Life Res. 2006 Nov;15(9):1503-18. Epub 2006 Sep 26.}, month = {Nov}, pages = {1503-18}, edition = {2006/10/13}, abstract = {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{\textquoteright}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.}, keywords = {*Computers, *Hispanic Americans, *Quality of Life, Adult, Aged, Data Collection/*methods, Diabetes Mellitus/*psychology, Feasibility Studies, Female, Humans, Language, Male, Middle Aged}, isbn = {0962-9343 (Print)}, author = {Schwartz, C. and Welch, G. and Santiago-Kelley, P. and Bode, R. and Sun, X.} } @article {237, title = {Factor analysis techniques for assessing sufficient unidimensionality of cancer related fatigue}, journal = {Quality of Life Research}, volume = {15}, number = {7}, year = {2006}, note = {0962-9343 (Print)Journal ArticleResearch Support, N.I.H., Extramural}, month = {Sep}, pages = {1179-90}, abstract = {BACKGROUND: Fatigue is the most common unrelieved symptom experienced by people with cancer. The purpose of this study was to examine whether cancer-related fatigue (CRF) can be summarized using a single score, that is, whether CRF is sufficiently unidimensional for measurement approaches that require or assume unidimensionality. We evaluated this question using factor analysis techniques including the theory-driven bi-factor model. METHODS: Five hundred and fifty five cancer patients from the Chicago metropolitan area completed a 72-item fatigue item bank, covering a range of fatigue-related concerns including intensity, frequency and interference with physical, mental, and social activities. Dimensionality was assessed using exploratory and confirmatory factor analysis (CFA) techniques. RESULTS: Exploratory factor analysis (EFA) techniques identified from 1 to 17 factors. The bi-factor model suggested that CRF was sufficiently unidimensional. CONCLUSIONS: CRF can be considered sufficiently unidimensional for applications that require unidimensionality. One such application, item response theory (IRT), will facilitate the development of short-form and computer-adaptive testing. This may further enable practical and accurate clinical assessment of CRF.}, keywords = {*Factor Analysis, Statistical, *Quality of Life, Aged, Chicago, Fatigue/*etiology, Female, Humans, Male, Middle Aged, Neoplasms/*complications, Questionnaires}, author = {Lai, J-S. and Crane, P. K. and Cella, D.} } @article {16, title = {Maximum information stratification method for controlling item exposure in computerized adaptive testing}, journal = {Psicothema}, volume = {18}, number = {1}, year = {2006}, note = {Barrada, Juan RamonMazuela, PalomaOlea, JulioResearch Support, Non-U.S. Gov{\textquoteright}tSpainPsicothemaPsicothema. 2006 Feb;18(1):156-9.}, month = {Feb}, pages = {156-159}, edition = {2007/02/14}, abstract = {The proposal for increasing the security in Computerized Adaptive Tests that has received most attention in recent years is the a-stratified method (AS - Chang and Ying, 1999): at the beginning of the test only items with low discrimination parameters (a) can be administered, with the values of the a parameters increasing as the test goes on. With this method, distribution of the exposure rates of the items is less skewed, while efficiency is maintained in trait-level estimation. The pseudo-guessing parameter (c), present in the three-parameter logistic model, is considered irrelevant, and is not used in the AS method. The Maximum Information Stratified (MIS) model incorporates the c parameter in the stratification of the bank and in the item-selection rule, improving accuracy by comparison with the AS, for item banks with a and b parameters correlated and uncorrelated. For both kinds of banks, the blocking b methods (Chang, Qian and Ying, 2001) improve the security of the item bank.M{\'e}todo de estratificaci{\'o}n por m{\'a}xima informaci{\'o}n para el control de la exposici{\'o}n en tests adaptativos informatizados. La propuesta para aumentar la seguridad en los tests adaptativos informatizados que ha recibido m{\'a}s atenci{\'o}n en los {\'u}ltimos a{\~n}os ha sido el m{\'e}todo a-estratificado (AE - Chang y Ying, 1999): en los momentos iniciales del test s{\'o}lo pueden administrarse {\'\i}tems con bajos par{\'a}metros de discriminaci{\'o}n (a), increment{\'a}ndose los valores del par{\'a}metro a admisibles seg{\'u}n avanza el test. Con este m{\'e}todo la distribuci{\'o}n de las tasas de exposici{\'o}n de los {\'\i}tems es m{\'a}s equilibrada, manteniendo una adecuada precisi{\'o}n en la medida. El par{\'a}metro de pseudoadivinaci{\'o}n (c), presente en el modelo log{\'\i}stico de tres par{\'a}metros, se supone irrelevante y no se incorpora en el AE. El m{\'e}todo de Estratificaci{\'o}n por M{\'a}xima Informaci{\'o}n (EMI) incorpora el par{\'a}metro c a la estratificaci{\'o}n del banco y a la regla de selecci{\'o}n de {\'\i}tems, mejorando la precisi{\'o}n en comparaci{\'o}n con AE, tanto para bancos donde los par{\'a}metros a y b correlacionan como para bancos donde no. Para ambos tipos de bancos, los m{\'e}todos de bloqueo de b (Chang, Qian y Ying, 2001) mejoran la seguridad del banco.}, keywords = {*Artificial Intelligence, *Microcomputers, *Psychological Tests, *Software Design, Algorithms, Chi-Square Distribution, Humans, Likelihood Functions}, isbn = {0214-9915 (Print)}, author = {Barrada, J and Mazuela, P. and Olea, J.} } @article {174, title = {Measurement precision and efficiency of multidimensional computer adaptive testing of physical functioning using the pediatric evaluation of disability inventory}, journal = {Archives of Physical Medicine and Rehabilitation}, volume = {87}, number = {9}, year = {2006}, note = {Haley, Stephen MNi, PengshengLudlow, Larry HFragala-Pinkham, Maria AK02 hd45354-01/hd/nichdResearch Support, N.I.H., ExtramuralResearch Support, Non-U.S. Gov{\textquoteright}tUnited StatesArchives of physical medicine and rehabilitationArch Phys Med Rehabil. 2006 Sep;87(9):1223-9.}, month = {Sep}, pages = {1223-9}, edition = {2006/08/29}, abstract = {OBJECTIVE: To compare the measurement efficiency and precision of a multidimensional computer adaptive testing (M-CAT) application to a unidimensional CAT (U-CAT) comparison using item bank data from 2 of the functional skills scales of the Pediatric Evaluation of Disability Inventory (PEDI). DESIGN: Using existing PEDI mobility and self-care item banks, we compared the stability of item calibrations and model fit between unidimensional and multidimensional Rasch models and compared the efficiency and precision of the U-CAT- and M-CAT-simulated assessments to a random draw of items. SETTING: Pediatric rehabilitation hospital and clinics. PARTICIPANTS: Clinical and normative samples. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: The M-CAT had greater levels of precision and efficiency than the separate mobility and self-care U-CAT versions when using a similar number of items for each PEDI subdomain. Equivalent estimation of mobility and self-care scores can be achieved with a 25\% to 40\% item reduction with the M-CAT compared with the U-CAT. CONCLUSIONS: M-CAT applications appear to have both precision and efficiency advantages compared with separate U-CAT assessments when content subdomains have a high correlation. Practitioners may also realize interpretive advantages of reporting test score information for each subdomain when separate clinical inferences are desired.}, keywords = {*Disability Evaluation, *Pediatrics, Adolescent, Child, Child, Preschool, Computers, Disabled Persons/*classification/rehabilitation, Efficiency, Humans, Infant, Outcome Assessment (Health Care), Psychometrics, Self Care}, isbn = {0003-9993 (Print)}, author = {Haley, S. M. and Ni, P. and Ludlow, L. H. and Fragala-Pinkham, M. A.} } @article {311, title = {Multidimensional computerized adaptive testing of the EORTC QLQ-C30: basic developments and evaluations}, journal = {Quality of Life Research}, volume = {15}, number = {3}, year = {2006}, note = {Petersen, Morten AaGroenvold, MogensAaronson, NeilFayers, PeterSprangers, MirjamBjorner, Jakob BEuropean Organisation for Research and Treatment of Cancer Quality of Life GroupResearch Support, Non-U.S. Gov{\textquoteright}tNetherlandsQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitationQual Life Res. 2006 Apr;15(3):315-29.}, month = {Apr}, pages = {315-29}, edition = {2006/03/21}, abstract = {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.}, keywords = {*Quality of Life, *Self Disclosure, Adult, Female, Health Status, Humans, Male, Middle Aged, Questionnaires/*standards, User-Computer Interface}, isbn = {0962-9343 (Print)}, author = {Petersen, M. A. and Groenvold, M. and Aaronson, N. K. and Fayers, P. and Sprangers, M. and Bjorner, J. B.} } @article {384, title = {Overview of quantitative measurement methods. Equivalence, invariance, and differential item functioning in health applications}, journal = {Medical Care}, volume = {44}, number = {11 Suppl 3}, year = {2006}, note = {Teresi, Jeanne AAG15294/AG/NIA NIH HHS/United StatesResearch Support, N.I.H., ExtramuralResearch Support, Non-U.S. Gov{\textquoteright}tReviewUnited StatesMedical careMed Care. 2006 Nov;44(11 Suppl 3):S39-49.}, month = {Nov}, pages = {S39-49}, edition = {2006/10/25}, abstract = {BACKGROUND: Reviewed in this article are issues relating to the study of invariance and differential item functioning (DIF). The aim of factor analyses and DIF, in the context of invariance testing, is the examination of group differences in item response conditional on an estimate of disability. Discussed are parameters and statistics that are not invariant and cannot be compared validly in crosscultural studies with varying distributions of disability in contrast to those that can be compared (if the model assumptions are met) because they are produced by models such as linear and nonlinear regression. OBJECTIVES: The purpose of this overview is to provide an integrated approach to the quantitative methods used in this special issue to examine measurement equivalence. The methods include classical test theory (CTT), factor analytic, and parametric and nonparametric approaches to DIF detection. Also included in the quantitative section is a discussion of item banking and computerized adaptive testing (CAT). METHODS: Factorial invariance and the articles discussing this topic are introduced. A brief overview of the DIF methods presented in the quantitative section of the special issue is provided together with a discussion of ways in which DIF analyses and examination of invariance using factor models may be complementary. CONCLUSIONS: Although factor analytic and DIF detection methods share features, they provide unique information and can be viewed as complementary in informing about measurement equivalence.}, keywords = {*Cross-Cultural Comparison, Data Interpretation, Statistical, Factor Analysis, Statistical, Guidelines as Topic, Humans, Models, Statistical, Psychometrics/*methods, Statistics as Topic/*methods, Statistics, Nonparametric}, isbn = {0025-7079 (Print)0025-7079 (Linking)}, author = {Teresi, J. A.} } @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 {175, title = {Assessing mobility in children using a computer adaptive testing version of the pediatric evaluation of disability inventory}, journal = {Archives of Physical Medicine and Rehabilitation}, volume = {86}, number = {5}, year = {2005}, note = {Haley, Stephen MRaczek, Anastasia ECoster, Wendy JDumas, Helene MFragala-Pinkham, Maria AK02 hd45354-01a1/hd/nichdR43 hd42388-01/hd/nichdResearch Support, N.I.H., ExtramuralResearch Support, U.S. Gov{\textquoteright}t, P.H.S.United StatesArchives of physical medicine and rehabilitationArch Phys Med Rehabil. 2005 May;86(5):932-9.}, month = {May}, pages = {932-9}, edition = {2005/05/17}, abstract = {OBJECTIVE: To assess score agreement, validity, precision, and response burden of a prototype computerized adaptive testing (CAT) version of the Mobility Functional Skills Scale (Mob-CAT) of the Pediatric Evaluation of Disability Inventory (PEDI) as compared with the full 59-item version (Mob-59). DESIGN: Computer simulation analysis of cross-sectional and longitudinal retrospective data; and cross-sectional prospective study. SETTING: Pediatric rehabilitation hospital, including inpatient acute rehabilitation, day school program, outpatient clinics, community-based day care, preschool, and children{\textquoteright}s homes. PARTICIPANTS: Four hundred sixty-nine children with disabilities and 412 children with no disabilities (analytic sample); 41 children without disabilities and 39 with disabilities (cross-validation sample). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Summary scores from a prototype Mob-CAT application and versions using 15-, 10-, and 5-item stopping rules; scores from the Mob-59; and number of items and time (in seconds) to administer assessments. RESULTS: Mob-CAT scores from both computer simulations (intraclass correlation coefficient [ICC] range, .94-.99) and field administrations (ICC=.98) were in high agreement with scores from the Mob-59. Using computer simulations of retrospective data, discriminant validity, and sensitivity to change of the Mob-CAT closely approximated that of the Mob-59, especially when using the 15- and 10-item stopping rule versions of the Mob-CAT. The Mob-CAT used no more than 15\% of the items for any single administration, and required 20\% of the time needed to administer the Mob-59. CONCLUSIONS: Comparable score estimates for the PEDI mobility scale can be obtained from CAT administrations, with losses in validity and precision for shorter forms, but with a considerable reduction in administration time.}, keywords = {*Computer Simulation, *Disability Evaluation, Adolescent, Child, Child, Preschool, Cross-Sectional Studies, Disabled Children/*rehabilitation, Female, Humans, Infant, Male, Outcome Assessment (Health Care)/*methods, Rehabilitation Centers, Rehabilitation/*standards, Sensitivity and Specificity}, isbn = {0003-9993 (Print)}, author = {Haley, S. M. and Raczek, A. E. and Coster, W. J. and Dumas, H. M. and Fragala-Pinkham, M. A.} } @article {150, title = {Computer adaptive testing}, journal = {Journal of Applied Measurement}, volume = {6}, number = {1}, year = {2005}, note = {Gershon, Richard CReviewUnited StatesJournal of applied measurementJ Appl Meas. 2005;6(1):109-27.}, pages = {109-27}, edition = {2005/02/11}, abstract = {The creation of item response theory (IRT) and Rasch models, inexpensive accessibility to high speed desktop computers, and the growth of the Internet, has led to the creation and growth of computerized adaptive testing or CAT. This form of assessment is applicable for both high stakes tests such as certification or licensure exams, as well as health related quality of life surveys. This article discusses the historical background of CAT including its many advantages over conventional (typically paper and pencil) alternatives. The process of CAT is then described including descriptions of the specific differences of using CAT based upon 1-, 2- and 3-parameter IRT and various Rasch models. Numerous specific topics describing CAT in practice are described including: initial item selection, content balancing, test difficulty, test length and stopping rules. The article concludes with the author{\textquoteright}s reflections regarding the future of CAT.}, keywords = {*Internet, *Models, Statistical, *User-Computer Interface, Certification, Health Surveys, Humans, Licensure, Microcomputers, Quality of Life}, isbn = {1529-7713 (Print)}, author = {Gershon, R. C.} } @article {171, title = {A computer adaptive testing approach for assessing physical functioning in children and adolescents}, journal = {Developmental Medicine and Child Neuropsychology}, volume = {47}, number = {2}, year = {2005}, note = {Haley, Stephen MNi, PengshengFragala-Pinkham, Maria ASkrinar, Alison MCorzo, DeyaniraComparative StudyResearch Support, Non-U.S. Gov{\textquoteright}tEnglandDevelopmental medicine and child neurologyDev Med Child Neurol. 2005 Feb;47(2):113-20.}, month = {Feb}, pages = {113-120}, edition = {2005/02/15}, abstract = {The purpose of this article is to demonstrate: (1) the accuracy and (2) the reduction in amount of time and effort in assessing physical functioning (self-care and mobility domains) of children and adolescents using computer-adaptive testing (CAT). A CAT algorithm selects questions directly tailored to the child{\textquoteright}s ability level, based on previous responses. Using a CAT algorithm, a simulation study was used to determine the number of items necessary to approximate the score of a full-length assessment. We built simulated CAT (5-, 10-, 15-, and 20-item versions) for self-care and mobility domains and tested their accuracy in a normative sample (n=373; 190 males, 183 females; mean age 6y 11mo [SD 4y 2m], range 4mo to 14y 11mo) and a sample of children and adolescents with Pompe disease (n=26; 21 males, 5 females; mean age 6y 1mo [SD 3y 10mo], range 5mo to 14y 10mo). Results indicated that comparable score estimates (based on computer simulations) to the full-length tests can be achieved in a 20-item CAT version for all age ranges and for normative and clinical samples. No more than 13 to 16\% of the items in the full-length tests were needed for any one administration. These results support further consideration of using CAT programs for accurate and efficient clinical assessments of physical functioning.}, keywords = {*Computer Systems, Activities of Daily Living, Adolescent, Age Factors, Child, Child Development/*physiology, Child, Preschool, Computer Simulation, Confidence Intervals, Demography, Female, Glycogen Storage Disease Type II/physiopathology, Health Status Indicators, Humans, Infant, Infant, Newborn, Male, Motor Activity/*physiology, Outcome Assessment (Health Care)/*methods, Reproducibility of Results, Self Care, Sensitivity and Specificity}, isbn = {0012-1622 (Print)}, author = {Haley, S. M. and Ni, P. and Fragala-Pinkham, M. A. and Skrinar, A. M. and Corzo, D.} } @article {249, title = {Computerized adaptive testing: a mixture item selection approach for constrained situations}, journal = {British Journal of Mathematical and Statistical Psychology}, volume = {58}, number = {2}, year = {2005}, note = {Leung, Chi-KeungChang, Hua-HuaHau, Kit-TaiEnglandBr J Math Stat Psychol. 2005 Nov;58(Pt 2):239-57.}, month = {Nov}, pages = {239-57}, edition = {2005/11/19}, abstract = {In computerized adaptive testing (CAT), traditionally the most discriminating items are selected to provide the maximum information so as to attain the highest efficiency in trait (theta) estimation. The maximum information (MI) approach typically results in unbalanced item exposure and hence high item-overlap rates across examinees. Recently, Yi and Chang (2003) proposed the multiple stratification (MS) method to remedy the shortcomings of MI. In MS, items are first sorted according to content, then difficulty and finally discrimination parameters. As discriminating items are used strategically, MS offers a better utilization of the entire item pool. However, for testing with imposed non-statistical constraints, this new stratification approach may not maintain its high efficiency. Through a series of simulation studies, this research explored the possible benefits of a mixture item selection approach (MS-MI), integrating the MS and MI approaches, in testing with non-statistical constraints. In all simulation conditions, MS consistently outperformed the other two competing approaches in item pool utilization, while the MS-MI and the MI approaches yielded higher measurement efficiency and offered better conformity to the constraints. Furthermore, the MS-MI approach was shown to perform better than MI on all evaluation criteria when control of item exposure was imposed.}, keywords = {*Computer-Aided Design, *Educational Measurement/methods, *Models, Psychological, Humans, Psychometrics/methods}, isbn = {0007-1102 (Print)0007-1102 (Linking)}, author = {Leung, C. K. and Chang, Hua-Hua and Hau, K. T.} } @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 {121, title = {Data pooling and analysis to build a preliminary item bank: an example using bowel function in prostate cancer}, journal = {Evaluation and the Health Professions}, volume = {28}, number = {2}, year = {2005}, note = {0163-2787 (Print)Journal Article}, pages = {142-59}, abstract = {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.}, keywords = {*Quality of Life, *Questionnaires, Adult, Aged, Data Collection/methods, Humans, Intestine, Large/*physiopathology, Male, Middle Aged, Prostatic Neoplasms/*physiopathology, Psychometrics, Research Support, Non-U.S. Gov{\textquoteright}t, Statistics, Nonparametric}, author = {Eton, D. T. and Lai, J. S. and Cella, D. and Reeve, B. B. and Talcott, J. A. and Clark, J. A. and McPherson, C. P. and Litwin, M. S. and Moinpour, C. M.} } @article {236, title = {An item bank was created to improve the measurement of cancer-related fatigue}, journal = {Journal of Clinical Epidemiology}, volume = {58}, number = {2}, year = {2005}, note = {Lai, Jin-SheiCella, DavidDineen, KellyBode, RitaVon Roenn, JamieGershon, Richard CShevrin, DanielEnglandJ Clin Epidemiol. 2005 Feb;58(2):190-7.}, month = {Feb}, pages = {190-7}, type = {Multicenter Study}, edition = {2005/02/01}, abstract = {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.}, keywords = {Adult, Aged, Aged, 80 and over, Factor Analysis, Statistical, Fatigue/*etiology/psychology, Female, Humans, Male, Middle Aged, Neoplasms/*complications/psychology, Psychometrics, Questionnaires}, isbn = {0895-4356 (Print)0895-4356 (Linking)}, author = {Lai, J-S. and Cella, D. and Dineen, K. and Bode, R. and Von Roenn, J. and Gershon, R. C. and Shevrin, D.} } @article {357, title = {Measuring physical function in patients with complex medical and postsurgical conditions: a computer adaptive approach}, journal = {American Journal of Physical Medicine and Rehabilitation}, volume = {84}, number = {10}, year = {2005}, note = {0894-9115 (Print)Comparative StudyJournal ArticleResearch Support, N.I.H., ExtramuralResearch Support, U.S. Gov{\textquoteright}t, P.H.S.}, month = {Oct}, pages = {741-8}, abstract = {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.}, keywords = {Activities of Daily Living/*classification, Adult, Aged, Cohort Studies, Continuity of Patient Care, Disability Evaluation, Female, Health Services Research, Humans, Male, Middle Aged, Postoperative Care/*rehabilitation, Prognosis, Recovery of Function, Rehabilitation Centers, Rehabilitation/*standards, Sensitivity and Specificity, Sickness Impact Profile, Treatment Outcome}, author = {Siebens, H. and Andres, P. L. and Pengsheng, N. and Coster, W. J. and Haley, S. M.} } @article {185, title = {Simulated computerized adaptive tests for measuring functional status were efficient with good discriminant validity in patients with hip, knee, or foot/ankle impairments}, journal = {Journal of Clinical Epidemiology}, volume = {58}, number = {6}, year = {2005}, note = {0895-4356 (Print)Journal ArticleMulticenter StudyValidation Studies}, pages = {629-38}, abstract = {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.}, keywords = {*Health Status Indicators, Activities of Daily Living, Adolescent, Adult, Aged, Aged, 80 and over, Ankle Joint/physiopathology, Diagnosis, Computer-Assisted/*methods, Female, Hip Joint/physiopathology, Humans, Joint Diseases/physiopathology/*rehabilitation, Knee Joint/physiopathology, Lower Extremity/*physiopathology, Male, Middle Aged, Research Support, N.I.H., Extramural, Research Support, U.S. Gov{\textquoteright}t, P.H.S., Retrospective Studies}, author = {Hart, D. L. and Mioduski, J. E. and Stratford, P. W.} } @booklet {201, title = {The AMC Linear Disability Score project in a population requiring residential care: psychometric properties}, journal = {Health and Quality of Life Outcomes}, volume = {2}, year = {2004}, note = {Holman, RebeccaLindeboom, RobertVermeulen, Marinusde Haan, Rob JResearch Support, Non-U.S. Gov{\textquoteright}tValidation StudiesEnglandHealth and quality of life outcomesHealth Qual Life Outcomes. 2004 Aug 3;2:42.}, month = {Aug 3}, pages = {42}, edition = {2004/08/05}, abstract = {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.}, keywords = {*Disability Evaluation, *Health Status Indicators, Activities of Daily Living/*classification, Adult, Aged, Aged, 80 and over, Data Collection/methods, Female, Humans, Logistic Models, Male, Middle Aged, Netherlands, Pilot Projects, Probability, Psychometrics/*instrumentation, Questionnaires/standards, Residential Facilities/*utilization, Severity of Illness Index}, isbn = {1477-7525 (Electronic)1477-7525 (Linking)}, author = {Holman, R. and Lindeboom, R. and Vermeulen, M. and de Haan, R. J.} } @article {8, title = {Computer adaptive testing: a strategy for monitoring stroke rehabilitation across settings}, journal = {Stroke Rehabilitation}, volume = {11}, number = {2}, year = {2004}, note = {Andres, Patricia LBlack-Schaffer, Randie MNi, PengshengHaley, Stephen MR01 hd43568/hd/nichdEvaluation StudiesResearch Support, U.S. Gov{\textquoteright}t, Non-P.H.S.Research Support, U.S. Gov{\textquoteright}t, P.H.S.United StatesTopics in stroke rehabilitationTop Stroke Rehabil. 2004 Spring;11(2):33-9.}, month = {Spring}, pages = {33-39}, edition = {2004/05/01}, abstract = {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{\textquoteright}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.}, keywords = {*Computer Simulation, *User-Computer Interface, Adult, Aged, Aged, 80 and over, Cerebrovascular Accident/*rehabilitation, Disabled Persons/*classification, Female, Humans, Male, Middle Aged, Monitoring, Physiologic/methods, Severity of Illness Index, Task Performance and Analysis}, isbn = {1074-9357 (Print)}, author = {Andres, P. L. and Black-Schaffer, R. M. and Ni, P. and Haley, S. M.} } @article {338, title = {A computerized adaptive knowledge test as an assessment tool in general practice: a pilot study}, journal = {Medical Teacher}, volume = {26}, number = {2}, year = {2004}, note = {0142-159xJournal Article}, month = {Mar}, pages = {178-83}, abstract = {Advantageous to assessment in many fields, CAT (computerized adaptive testing) use in general practice has been scarce. In adapting CAT to general practice, the basic assumptions of item response theory and the case specificity must be taken into account. In this context, this study first evaluated the feasibility of converting written extended matching tests into CAT. Second, it questioned the content validity of CAT. A stratified sample of students was invited to participate in the pilot study. The items used in this test, together with their parameters, originated from the written test. The detailed test paths of the students were retained and analysed thoroughly. Using the predefined pass-fail standard, one student failed the test. There was a positive correlation between the number of items and the candidate{\textquoteright}s ability level. The majority of students were presented with questions in seven of the 10 existing domains. Although proved to be a feasible test format, CAT cannot substitute for the existing high-stakes large-scale written test. It may provide a reliable instrument for identifying candidates who are at risk of failing in the written test.}, keywords = {*Computer Systems, Algorithms, Educational Measurement/*methods, Family Practice/*education, Humans, Pilot Projects}, author = {Roex, A. and Degryse, J.} } @article {147, title = {Computerized adaptive measurement of depression: A simulation study}, journal = {BMC Psychiatry}, volume = {4}, number = {1}, year = {2004}, pages = {13-23}, abstract = {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.}, keywords = {*Computer Simulation, Adult, Algorithms, Area Under Curve, Comparative Study, Depressive Disorder/*diagnosis/epidemiology/psychology, Diagnosis, Computer-Assisted/*methods/statistics \& numerical data, Factor Analysis, Statistical, Female, Humans, Internet, Male, Mass Screening/methods, Patient Selection, Personality Inventory/*statistics \& numerical data, Pilot Projects, Prevalence, Psychiatric Status Rating Scales/*statistics \& numerical data, Psychometrics, Research Support, Non-U.S. Gov{\textquoteright}t, Research Support, U.S. Gov{\textquoteright}t, P.H.S., Severity of Illness Index, Software}, author = {Gardner, W. and Shear, K. and Kelleher, K. J. and Pajer, K. A. and Mammen, O. and Buysse, D. and Frank, E.} } @booklet {200, title = {Practical methods for dealing with {\textquoteright}not applicable{\textquoteright} item responses in the AMC Linear Disability Score project}, journal = {Health and Quality of Life Outcomes}, volume = {2}, year = {2004}, note = {Holman, RebeccaGlas, Cees A WLindeboom, RobertZwinderman, Aeilko Hde Haan, Rob JEnglandHealth Qual Life Outcomes. 2004 Jun 16;2:29.}, month = {Jun 16}, pages = {29}, type = {Comparative StudyResearch Support, Non-U.S. Gov{\textquoteright}t}, edition = {2004/06/18}, abstract = {BACKGROUND: Whenever questionnaires are used to collect data on constructs, such as functional status or health related quality of life, it is unlikely that all respondents will respond to all items. This paper examines ways of dealing with responses in a {\textquoteright}not applicable{\textquoteright} category to items included in the AMC Linear Disability Score (ALDS) project item bank. METHODS: The data examined in this paper come from the responses of 392 respondents to 32 items and form part of the calibration sample for the ALDS item bank. The data are analysed using the one-parameter logistic item response theory model. The four practical strategies for dealing with this type of response are: cold deck imputation; hot deck imputation; treating the missing responses as if these items had never been offered to those individual patients; and using a model which takes account of the {\textquoteright}tendency to respond to items{\textquoteright}. RESULTS: The item and respondent population parameter estimates were very similar for the strategies involving hot deck imputation; treating the missing responses as if these items had never been offered to those individual patients; and using a model which takes account of the {\textquoteright}tendency to respond to items{\textquoteright}. The estimates obtained using the cold deck imputation method were substantially different. CONCLUSIONS: The cold deck imputation method was not considered suitable for use in the ALDS item bank. The other three methods described can be usefully implemented in the ALDS item bank, depending on the purpose of the data analysis to be carried out. These three methods may be useful for other data sets examining similar constructs, when item response theory based methods are used.}, keywords = {*Disability Evaluation, *Health Surveys, *Logistic Models, *Questionnaires, Activities of Daily Living/*classification, Data Interpretation, Statistical, Health Status, Humans, Pilot Projects, Probability, Quality of Life, Severity of Illness Index}, isbn = {1477-7525 (Electronic)1477-7525 (Linking)}, author = {Holman, R. and Glas, C. A. and Lindeboom, R. and Zwinderman, A. H. and de Haan, R. J.} } @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 {167, title = {Score comparability of short forms and computerized adaptive testing: Simulation study with the activity measure for post-acute care}, journal = {Archives of Physical Medicine and Rehabilitation}, volume = {85}, number = {4}, year = {2004}, note = {Haley, Stephen MCoster, Wendy JAndres, Patricia LKosinski, MarkNi, PengshengR01 hd43568/hd/nichdComparative StudyMulticenter StudyResearch Support, U.S. Gov{\textquoteright}t, Non-P.H.S.Research Support, U.S. Gov{\textquoteright}t, P.H.S.United StatesArchives of physical medicine and rehabilitationArch Phys Med Rehabil. 2004 Apr;85(4):661-6.}, month = {Apr}, pages = {661-6}, edition = {2004/04/15}, abstract = {OBJECTIVE: To compare simulated short-form and computerized adaptive testing (CAT) scores to scores obtained from complete item sets for each of the 3 domains of the Activity Measure for Post-Acute Care (AM-PAC). DESIGN: Prospective study. SETTING: Six postacute health care networks in the greater Boston metropolitan area, including inpatient acute rehabilitation, transitional care units, home care, and outpatient services. PARTICIPANTS: A convenience sample of 485 adult volunteers who were receiving skilled rehabilitation services. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Inpatient and community-based short forms and CAT applications were developed for each of 3 activity domains (physical \& mobility, personal care \& instrumental, applied cognition) using item pools constructed from new items and items from existing postacute care instruments. RESULTS: Simulated CAT scores correlated highly with score estimates from the total item pool in each domain (4- and 6-item CAT r range,.90-.95; 10-item CAT r range,.96-.98). Scores on the 10-item short forms constructed for inpatient and community settings also provided good estimates of the AM-PAC item pool scores for the physical \& movement and personal care \& instrumental domains, but were less consistent in the applied cognition domain. Confidence intervals around individual scores were greater in the short forms than for the CATs. CONCLUSIONS: Accurate scoring estimates for AM-PAC domains can be obtained with either the setting-specific short forms or the CATs. The strong relationship between CAT and item pool scores can be attributed to the CAT{\textquoteright}s ability to select specific items to match individual responses. The CAT may have additional advantages over short forms in practicality, efficiency, and the potential for providing more precise scoring estimates for individuals.}, keywords = {Boston, Factor Analysis, Statistical, Humans, Outcome Assessment (Health Care)/*methods, Prospective Studies, Questionnaires/standards, Rehabilitation/*standards, Subacute Care/*standards}, isbn = {0003-9993 (Print)}, author = {Haley, S. M. and Coster, W. J. and Andres, P. L. and Kosinski, M. and Ni, P.} } @article {34, title = {Developing an initial physical function item bank from existing sources}, journal = {Journal of Applied Measurement}, volume = {4}, number = {2}, year = {2003}, note = {1529-7713Journal Article}, pages = {124-36}, abstract = {The objective of this article is to illustrate incremental item banking using health-related quality of life data collected from two samples of patients receiving cancer treatment. The kinds of decisions one faces in establishing an item bank for computerized adaptive testing are also illustrated. Pre-calibration procedures include: identifying common items across databases; creating a new database with data from each pool; reverse-scoring "negative" items; identifying rating scales used in items; identifying pivot points in each rating scale; pivot anchoring items at comparable rating scale categories; and identifying items in each instrument that measure the construct of interest. A series of calibrations were conducted in which a small proportion of new items were added to the common core and misfitting items were identified and deleted until an initial item bank has been developed.}, keywords = {*Databases, *Sickness Impact Profile, Adaptation, Psychological, Data Collection, Humans, Neoplasms/*physiopathology/psychology/therapy, Psychometrics, Quality of Life/*psychology, Research Support, U.S. Gov{\textquoteright}t, P.H.S., United States}, author = {Bode, R. K. and Cella, D. and Lai, J. S. and Heinemann, A. W.} } @article {96, title = {An examination of exposure control and content balancing restrictions on item selection in CATs using the partial credit model}, journal = {Journal of Applied Measurement}, volume = {4}, number = {1}, year = {2003}, note = {1529-7713Journal Article}, pages = {24-42}, abstract = {The purpose of the present investigation was to systematically examine the effectiveness of the Sympson-Hetter technique and rotated content balancing relative to no exposure control and no content rotation conditions in a computerized adaptive testing system (CAT) based on the partial credit model. A series of simulated fixed and variable length CATs were run using two data sets generated to multiple content areas for three sizes of item pools. The 2 (exposure control) X 2 (content rotation) X 2 (test length) X 3 (item pool size) X 2 (data sets) yielded a total of 48 conditions. Results show that while both procedures can be used with no deleterious effect on measurement precision, the gains in exposure control, pool utilization, and item overlap appear quite modest. Difficulties involved with setting the exposure control parameters in small item pools make questionable the utility of the Sympson-Hetter technique with similar item pools.}, keywords = {*Computers, *Educational Measurement, *Models, Theoretical, Automation, Decision Making, Humans, Reproducibility of Results}, author = {Davis, L. L. and Pastor, D. A. and Dodd, B. G. and Chiang, C. and Fitzpatrick, S. J.} } @article {238, title = {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}, journal = {Quality of Life Research}, volume = {12}, number = {5}, year = {2003}, note = {0962-9343Journal Article}, month = {Aug}, pages = {485-501}, abstract = {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{\textquoteright}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.}, keywords = {*Health Status Indicators, *Questionnaires, Adult, Fatigue/*diagnosis/etiology, Female, Humans, Male, Middle Aged, Neoplasms/complications, Psychometrics, Research Support, Non-U.S. Gov{\textquoteright}t, Research Support, U.S. Gov{\textquoteright}t, P.H.S., Sickness Impact Profile}, author = {Lai, J-S. and Crane, P. K. and Cella, D. and Chang, C-H. and Bode, R. K. and Heinemann, A. W.} } @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.} } @article {48, title = {Advances in quality of life measurements in oncology patients}, journal = {Seminars in Oncology}, volume = {29}, number = {3 Suppl 8}, year = {2002}, note = {0093-7754 (Print)Journal ArticleReview}, month = {Jun}, pages = {60-8}, abstract = {Accurate assessment of the quality of life (QOL) of patients can provide important clinical information to physicians, especially in the area of oncology. Changes in QOL are important indicators of the impact of a new cytotoxic therapy, can affect a patient{\textquoteright}s willingness to continue treatment, and may aid in defining response in the absence of quantifiable endpoints such as tumor regression. Because QOL is becoming an increasingly important aspect in the management of patients with malignant disease, it is vital that the instruments used to measure QOL are reliable and accurate. Assessment of QOL involves a multidimensional approach that includes physical, functional, social, and emotional well-being, and the most comprehensive instruments measure at least three of these domains. Instruments to measure QOL can be generic (eg, the Nottingham Health Profile), targeted toward specific illnesses (eg, Functional Assessment of Cancer Therapy - Lung), or be a combination of generic and targeted. Two of the most widely used examples of the combination, or hybrid, instruments are the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 Items and the Functional Assessment of Chronic Illness Therapy. A consequence of the increasing international collaboration in clinical trials has been the growing necessity for instruments that are valid across languages and cultures. To assure the continuing reliability and validity of QOL instruments in this regard, item response theory can be applied. Techniques such as item response theory may be used in the future to construct QOL item banks containing large sets of validated questions that represent various levels of QOL domains. As QOL becomes increasingly important in understanding and approaching the overall management of cancer patients, the tools available to clinicians and researchers to assess QOL will continue to evolve. While the instruments currently available provide reliable and valid measurement, further improvements in precision and application are anticipated.}, keywords = {*Quality of Life, *Sickness Impact Profile, Cross-Cultural Comparison, Culture, Humans, Language, Neoplasms/*physiopathology, Questionnaires}, author = {Cella, D. and Chang, C-H. and Lai, J. S. and Webster, K.} } @article {305, title = {Assessing tobacco beliefs among youth using item response theory models}, journal = {Drug and Alcohol Dependence}, volume = {68}, number = {Suppl 1}, year = {2002}, note = {0376-8716Journal Article}, month = {Nov}, pages = {S21-S39}, abstract = {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.}, keywords = {*Attitude to Health, *Culture, *Health Behavior, *Questionnaires, Adolescent, Adult, Child, Female, Humans, Male, Models, Statistical, Smoking/*epidemiology}, author = {Panter, A. T. and Reeve, B. B.} } @article {187, title = {Development of an index of physical functional health status in rehabilitation}, journal = {Archives of Physical Medicine and Rehabilitation}, volume = {83}, number = {5}, year = {2002}, note = {0003-9993 (Print)Journal Article}, month = {May}, pages = {655-65}, abstract = {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{\textquoteright}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.}, keywords = {*Health Status Indicators, *Rehabilitation Centers, Adolescent, Adult, Aged, Aged, 80 and over, Female, Health Surveys, Humans, Male, Middle Aged, Musculoskeletal Diseases/*physiopathology/*rehabilitation, Nervous System Diseases/*physiopathology/*rehabilitation, Physical Fitness/*physiology, Recovery of Function/physiology, Reproducibility of Results, Retrospective Studies}, author = {Hart, D. L. and Wright, B. D.} } @article {50, title = {Measuring quality of life in chronic illness: the functional assessment of chronic illness therapy measurement system}, journal = {Archives of Physical Medicine and Rehabilitation}, volume = {83}, number = {12 Suppl 2}, year = {2002}, note = {0003-9993Journal Article}, month = {Dec}, pages = {S10-7}, abstract = {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.}, keywords = {*Chronic Disease, *Quality of Life, *Rehabilitation, Adult, Comparative Study, Health Status Indicators, Humans, Psychometrics, Questionnaires, Research Support, U.S. Gov{\textquoteright}t, P.H.S., Sensitivity and Specificity}, author = {Cella, D. and Nowinski, C. J.} } @article {146, title = {Multidimensional adaptive testing for mental health problems in primary care}, journal = {Medical Care}, volume = {40}, number = {9}, year = {2002}, note = {Gardner, WilliamKelleher, Kelly JPajer, Kathleen AMCJ-177022/PHS HHS/MH30915/MH/NIMH NIH HHS/MH50629/MH/NIMH NIH HHS/Med Care. 2002 Sep;40(9):812-23.}, month = {Sep}, pages = {812-23}, edition = {2002/09/10}, abstract = {OBJECTIVES: Efficient and accurate instruments for assessing child psychopathology are increasingly important in clinical practice and research. For example, screening in primary care settings can identify children and adolescents with disorders that may otherwise go undetected. However, primary care offices are notorious for the brevity of visits and screening must not burden patients or staff with long questionnaires. One solution is to shorten assessment instruments, but dropping questions typically makes an instrument less accurate. An alternative is adaptive testing, in which a computer selects the items to be asked of a patient based on the patient{\textquoteright}s previous responses. This research used a simulation to test a child mental health screen based on this technology. RESEARCH DESIGN: Using half of a large sample of data, a computerized version was developed of the Pediatric Symptom Checklist (PSC), a parental-report psychosocial problem screen. With the unused data, a simulation was conducted to determine whether the Adaptive PSC can reproduce the results of the full PSC with greater efficiency. SUBJECTS: PSCs were completed by parents on 21,150 children seen in a national sample of primary care practices. RESULTS: Four latent psychosocial problem dimensions were identified through factor analysis: internalizing problems, externalizing problems, attention problems, and school problems. A simulated adaptive test measuring these traits asked an average of 11.6 questions per patient, and asked five or fewer questions for 49\% of the sample. There was high agreement between the adaptive test and the full (35-item) PSC: only 1.3\% of screening decisions were discordant (kappa = 0.93). This agreement was higher than that obtained using a comparable length (12-item) short-form PSC (3.2\% of decisions discordant; kappa = 0.84). CONCLUSIONS: Multidimensional adaptive testing may be an accurate and efficient technology for screening for mental health problems in primary care settings.}, keywords = {Adolescent, Child, Child Behavior Disorders/*diagnosis, Child Health Services/*organization \& administration, Factor Analysis, Statistical, Female, Humans, Linear Models, Male, Mass Screening/*methods, Parents, Primary Health Care/*organization \& administration}, isbn = {0025-7079 (Print)0025-7079 (Linking)}, author = {Gardner, W. and Kelleher, K. J. and Pajer, K. A.} } @article {21, title = {NCLEX-RN performance: predicting success on the computerized examination}, journal = {Journal of Professional Nursing}, volume = {17}, number = {4}, year = {2001}, note = {8755-7223Journal Article}, month = {Jul-Aug}, pages = {158-165}, abstract = {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.}, keywords = {*Education, Nursing, Baccalaureate, *Educational Measurement, *Licensure, Adult, Female, Humans, Male, Predictive Value of Tests, Software}, author = {Beeman, P. B. and Waterhouse, J. K.} } @article {368, title = {CAT administration of language placement examinations}, journal = {Journal of Applied Measurement}, volume = {1}, number = {3}, year = {2000}, note = {1529-7713Journal Article}, pages = {292-302}, abstract = {This article describes the development of a computerized adaptive test for Cegep de Jonquiere, a community college located in Quebec, Canada. Computerized language proficiency testing allows the simultaneous presentation of sound stimuli as the question is being presented to the test-taker. With a properly calibrated bank of items, the language proficiency test can be offered in an adaptive framework. By adapting the test to the test-taker{\textquoteright}s level of ability, an assessment can be made with significantly fewer items. We also describe our initial attempt to detect instances in which "cheating low" is occurring. In the "cheating low" situation, test-takers deliberately answer questions incorrectly, questions that they are fully capable of answering correctly had they been taking the test honestly.}, keywords = {*Language, *Software, Aptitude Tests/*statistics \& numerical data, Educational Measurement/*statistics \& numerical data, Humans, Psychometrics, Reproducibility of Results, Research Support, Non-U.S. Gov{\textquoteright}t}, author = {Stahl, J. and Bergstrom, B. and Gershon, R. C.} } @article {329, title = {Computerization and adaptive administration of the NEO PI-R}, journal = {Assessment}, volume = {7}, number = {4}, year = {2000}, note = {1073-1911 (Print)Journal Article}, pages = {347-64}, abstract = {This study asks, how well does an item response theory (IRT) based computerized adaptive NEO PI-R work? To explore this question, real-data simulations (N = 1,059) were used to evaluate a maximum information item selection computerized adaptive test (CAT) algorithm. Findings indicated satisfactory recovery of full-scale facet scores with the administration of around four items per facet scale. Thus, the NEO PI-R could be reduced in half with little loss in precision by CAT administration. However, results also indicated that the CAT algorithm was not necessary. We found that for many scales, administering the "best" four items per facet scale would have produced similar results. In the conclusion, we discuss the future of computerized personality assessment and describe the role IRT methods might play in such assessments.}, keywords = {*Personality Inventory, Algorithms, California, Diagnosis, Computer-Assisted/*methods, Humans, Models, Psychological, Psychometrics/methods, Reproducibility of Results}, author = {Reise, S. P. and Henson, J. M.} } @article {28, title = {Competency gradient for child-parent centers}, journal = {Journal of Outcomes Measurement}, volume = {3}, number = {1}, year = {1999}, note = {1090-655X (Print)Journal ArticleResearch Support, U.S. Gov{\textquoteright}t, P.H.S.}, pages = {35-52}, abstract = {This report describes an implementation of the Rasch model during the longitudinal evaluation of a federally-funded early childhood preschool intervention program. An item bank is described for operationally defining a psychosocial construct called community life-skills competency, an expected teenage outcome of the preschool intervention. This analysis examined the position of teenage students on this scale structure, and investigated a pattern of cognitive operations necessary for students to pass community life-skills test items. Then this scale structure was correlated with nationally standardized reading and math achievement scores, teacher ratings, and school records to assess its validity as a measure of the community-related outcome goal for this intervention. The results show a functional relationship between years of early intervention and magnitude of effect on the life-skills competency variable.}, keywords = {*Models, Statistical, Activities of Daily Living/classification/psychology, Adolescent, Chicago, Child, Child, Preschool, Early Intervention (Education)/*statistics \& numerical data, Female, Follow-Up Studies, Humans, Male, Outcome and Process Assessment (Health Care)/*statistics \& numerical data}, author = {Bezruczko, N.} } @article {234, title = {Evaluating the usefulness of computerized adaptive testing for medical in-course assessment}, journal = {Academic Medicine}, volume = {74}, number = {10}, year = {1999}, note = {Kreiter, C DFerguson, KGruppen, L DUnited statesAcademic medicine : journal of the Association of American Medical CollegesAcad Med. 1999 Oct;74(10):1125-8.}, month = {Oct}, pages = {1125-8}, edition = {1999/10/28}, abstract = {PURPOSE: This study investigated the feasibility of converting an existing computer-administered, in-course internal medicine test to an adaptive format. METHOD: A 200-item internal medicine extended matching test was used for this research. Parameters were estimated with commercially available software with responses from 621 examinees. A specially developed simulation program was used to retrospectively estimate the efficiency of the computer-adaptive exam format. RESULTS: It was found that the average test length could be shortened by almost half with measurement precision approximately equal to that of the full 200-item paper-and-pencil test. However, computer-adaptive testing with this item bank provided little advantage for examinees at the upper end of the ability continuum. An examination of classical item statistics and IRT item statistics suggested that adding more difficult items might extend the advantage to this group of examinees. CONCLUSIONS: Medical item banks presently used for incourse assessment might be advantageously employed in adaptive testing. However, it is important to evaluate the match between the items and the measurement objective of the test before implementing this format.}, keywords = {*Automation, *Education, Medical, Undergraduate, Educational Measurement/*methods, Humans, Internal Medicine/*education, Likelihood Functions, Psychometrics/*methods, Reproducibility of Results}, isbn = {1040-2446 (Print)}, author = {Kreiter, C. D. and Ferguson, K. and Gruppen, L. D.} } @article {331, title = {Health status assessment for the twenty-first century: item response theory, item banking and computer adaptive testing}, journal = {Quality of Life Research}, volume = {6}, number = {6}, year = {1997}, note = {Revicki, D ACella, D FEnglandQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitationQual Life Res. 1997 Aug;6(6):595-600.}, month = {Aug}, pages = {595-600}, edition = {1997/08/01}, abstract = {Health status assessment is frequently used to evaluate the combined impact of human immunodeficiency virus (HIV) disease and its treatment on functioning and well-being from the patient{\textquoteright}s perspective. No single health status measure can efficiently cover the range of problems in functioning and well-being experienced across HIV disease stages. Item response theory (IRT), item banking and computer adaptive testing (CAT) provide a solution to measuring health-related quality of life (HRQoL) across different stages of HIV disease. IRT allows us to examine the response characteristics of individual items and the relationship between responses to individual items and the responses to each other item in a domain. With information on the response characteristics of a large number of items covering a HRQoL domain (e.g. physical function, and psychological well-being), and information on the interrelationships between all pairs of these items and the total scale, we can construct more efficient scales. Item banks consist of large sets of questions representing various levels of a HRQoL domain that can be used to develop brief, efficient scales for measuring the domain. CAT is the application of IRT and item banks to the tailored assessment of HRQoL domains specific to individual patients. Given the results of IRT analyses and computer-assisted test administration, more efficient and brief scales can be used to measure multiple domains of HRQoL for clinical trials and longitudinal observational studies.}, keywords = {*Health Status, *HIV Infections/diagnosis, *Quality of Life, Diagnosis, Computer-Assisted, Disease Progression, Humans, Psychometrics/*methods}, isbn = {0962-9343 (Print)}, author = {Revicki, D. A. and Cella, D. F.} } @article {369, title = {On-line performance assessment using rating scales}, journal = {Journal of Outcomes Measurement}, volume = {1}, number = {3}, year = {1997}, note = {1090-655X (Print)Journal Article}, pages = {173-191}, abstract = {The purpose of this paper is to report on the development of the on-line performance assessment instrument--the Assessment of Motor and Process Skills (AMPS). Issues that will be addressed in the paper include: (a) the establishment of the scoring rubric and its implementation in an extended Rasch model, (b) training of raters, (c) validation of the scoring rubric and procedures for monitoring the internal consistency of raters, and (d) technological implementation of the assessment instrument in a computerized program.}, keywords = {*Outcome Assessment (Health Care), *Rehabilitation, *Software, *Task Performance and Analysis, Activities of Daily Living, Humans, Microcomputers, Psychometrics, Psychomotor Performance}, author = {Stahl, J. and Shumway, R. and Bergstrom, B. and Fisher, A.} } @article {216, title = {Dispelling myths about the new NCLEX exam}, journal = {Recruitment, Retention, and Restructuring Report}, volume = {9}, number = {1}, year = {1996}, note = {Journal Article}, month = {Jan-Feb}, pages = {6-7}, abstract = {The new computerized NCLEX system is working well. Most new candidates, employers, and board of nursing representatives like the computerized adaptive testing system and the fast report of results. But, among the candidates themselves some myths have grown which cause them needless anxiety.}, keywords = {*Educational Measurement, *Licensure, Humans, Nursing Staff, Personnel Selection, United States}, author = {Johnson, S. H.} } @article {137, title = {Methodologic trends in the healthcare professions: computer adaptive and computer simulation testing}, journal = {Nurse Education}, volume = {21}, number = {4}, year = {1996}, note = {Forker, J EMcDonald, M EUnited statesNurse educatorNurse Educ. 1996 Jul-Aug;21(4):13-4.}, month = {Jul-Aug}, pages = {13-4}, edition = {1996/07/01}, abstract = {Assessing knowledge and performance on computer is rapidly becoming a common phenomenon in testing and measurement. Computer adaptive testing presents an individualized test format in accordance with the examinee{\textquoteright}s ability level. The efficiency of the testing process enables a more precise estimate of performance, often with fewer items than traditional paper-and-pencil testing methodologies. Computer simulation testing involves performance-based, or authentic, assessment of the examinee{\textquoteright}s clinical decision-making abilities. The authors discuss the trends in assessing performance through computerized means and the application of these methodologies to community-based nursing practice.}, keywords = {*Clinical Competence, *Computer Simulation, Computer-Assisted Instruction/*methods, Educational Measurement/*methods, Humans}, isbn = {0363-3624 (Print)0363-3624 (Linking)}, author = {Forker, J. E. and McDonald, M. E.} } @article {144, title = {A study of psychologically optimal level of item difficulty}, journal = {Shinrigaku Kenkyu}, volume = {65}, number = {6}, year = {1995}, note = {Fujimori, SClinical TrialControlled Clinical TrialEnglish AbstractJapanShinrigaku kenkyu : The Japanese journal of psychologyShinrigaku Kenkyu. 1995 Feb;65(6):446-53.}, month = {Feb}, pages = {446-53}, edition = {1995/02/01}, abstract = {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{\textquoteright}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.}, keywords = {*Adaptation, Psychological, *Psychological Tests, Adult, Female, Humans, Male}, isbn = {0021-5236 (Print)0021-5236 (Linking)}, author = {Fujimori, S.} } @article {178, title = {Computerized adaptive testing: the future is upon us}, journal = {Nurs Health Care}, volume = {14}, number = {7}, year = {1993}, note = {Halkitis, P NLeahy, J MUnited statesNursing \& health care : official publication of the National League for NursingNurs Health Care. 1993 Sep;14(7):378-85.}, month = {Sep}, pages = {378-85}, edition = {1993/09/01}, keywords = {*Computer-Assisted Instruction, *Education, Nursing, *Educational Measurement, *Reaction Time, Humans, Pharmacology/education, Psychometrics}, isbn = {0276-5284 (Print)}, author = {Halkitis, P. N. and Leahy, J. M.} } @article {126, title = {Computerized adaptive testing for NCLEX-PN}, journal = {Journal of Practical Nursing}, volume = {42}, number = {2}, year = {1992}, note = {Fields, F AUnited statesThe Journal of practical nursingJ Pract Nurs. 1992 Jun;42(2):8-10.}, month = {Jun}, pages = {8-10}, edition = {1992/06/01}, keywords = {*Licensure, *Programmed Instruction, Educational Measurement/*methods, Humans, Nursing, Practical/*education}, isbn = {0022-3867 (Print)}, author = {Fields, F. A.} }