TY - JOUR T1 - Computerized adaptive testing in back pain: Validation of the CAT-5D-QOL JF - Spine Y1 - 2008 A1 - Kopec, J. A. A1 - Badii, M. A1 - McKenna, M. A1 - Lima, V. D. A1 - Sayre, E. C. A1 - Dvorak, M. KW - *Disability Evaluation KW - *Health Status Indicators KW - *Quality of Life KW - Adult KW - Aged KW - Algorithms KW - Back Pain/*diagnosis/psychology KW - British Columbia KW - Diagnosis, Computer-Assisted/*standards KW - Feasibility Studies KW - Female KW - Humans KW - Internet KW - Male KW - Middle Aged KW - Predictive Value of Tests KW - Questionnaires/*standards KW - Reproducibility of Results AB - 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. VL - 33 SN - 1528-1159 (Electronic)0362-2436 (Linking) N1 - Kopec, Jacek ABadii, MaziarMcKenna, MarioLima, Viviane DSayre, Eric CDvorak, MarcelResearch Support, Non-U.S. Gov'tValidation StudiesUnited StatesSpineSpine (Phila Pa 1976). 2008 May 20;33(12):1384-90. ER - TY - JOUR T1 - Letting the CAT out of the bag: Comparing computer adaptive tests and an 11-item short form of the Roland-Morris Disability Questionnaire JF - Spine Y1 - 2008 A1 - Cook, K. F. A1 - Choi, S. W. A1 - Crane, P. K. A1 - Deyo, R. A. A1 - Johnson, K. L. A1 - Amtmann, D. KW - *Disability Evaluation KW - *Health Status Indicators KW - Adult KW - Aged KW - Aged, 80 and over KW - Back Pain/*diagnosis/psychology KW - Calibration KW - Computer Simulation KW - Diagnosis, Computer-Assisted/*standards KW - Humans KW - Middle Aged KW - Models, Psychological KW - Predictive Value of Tests KW - Questionnaires/*standards KW - Reproducibility of Results AB - 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'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. VL - 33 SN - 1528-1159 (Electronic) N1 - 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. ER -