TY - JOUR T1 - Measuring global physical health in children with cerebral palsy: Illustration of a multidimensional bi-factor model and computerized adaptive testing JF - Quality of Life Research Y1 - 2009 A1 - Haley, S. M. A1 - Ni, P. A1 - Dumas, H. M. A1 - Fragala-Pinkham, M. A. A1 - Hambleton, R. K. A1 - Montpetit, K. A1 - Bilodeau, N. A1 - Gorton, G. E. A1 - Watson, K. A1 - Tucker, C. A. KW - *Computer Simulation KW - *Health Status KW - *Models, Statistical KW - Adaptation, Psychological KW - Adolescent KW - Cerebral Palsy/*physiopathology KW - Child KW - Child, Preschool KW - Factor Analysis, Statistical KW - Female KW - Humans KW - Male KW - Massachusetts KW - Pennsylvania KW - Questionnaires KW - Young Adult AB - 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. VL - 18 SN - 0962-9343 (Print)0962-9343 (Linking) N1 - 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'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. U2 - 2692519 ER - TY - JOUR T1 - Reduction in patient burdens with graphical computerized adaptive testing on the ADL scale: tool development and simulation JF - Health and Quality of Life Outcomes Y1 - 2009 A1 - Chien, T. W. A1 - Wu, H. M. A1 - Wang, W-C. A1 - Castillo, R. V. A1 - Chou, W. KW - *Activities of Daily Living KW - *Computer Graphics KW - *Computer Simulation KW - *Diagnosis, Computer-Assisted KW - Female KW - Humans KW - Male KW - Point-of-Care Systems KW - Reproducibility of Results KW - Stroke/*rehabilitation KW - Taiwan KW - United States AB - 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. VL - 7 SN - 1477-7525 (Electronic)1477-7525 (Linking) N1 - 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. U2 - 2688502 ER - TY - JOUR T1 - Simulated computerized adaptive test for patients with shoulder impairments was efficient and produced valid measures of function JF - Journal of Clinical Epidemiology Y1 - 2006 A1 - Hart, D. L. A1 - Cook, K. F. A1 - Mioduski, J. E. A1 - Teal, C. R. A1 - Crane, P. K. KW - *Computer Simulation KW - *Range of Motion, Articular KW - Activities of Daily Living KW - Adult KW - Aged KW - Aged, 80 and over KW - Factor Analysis, Statistical KW - Female KW - Humans KW - Male KW - Middle Aged KW - Prospective Studies KW - Reproducibility of Results KW - Research Support, N.I.H., Extramural KW - Research Support, U.S. Gov't, Non-P.H.S. KW - Shoulder Dislocation/*physiopathology/psychology/rehabilitation KW - Shoulder Pain/*physiopathology/psychology/rehabilitation KW - Shoulder/*physiopathology KW - Sickness Impact Profile KW - Treatment Outcome AB - 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. VL - 59 N1 - 0895-4356 (Print)Journal ArticleValidation Studies ER - TY - JOUR T1 - Assessing mobility in children using a computer adaptive testing version of the pediatric evaluation of disability inventory JF - Archives of Physical Medicine and Rehabilitation Y1 - 2005 A1 - Haley, S. M. A1 - Raczek, A. E. A1 - Coster, W. J. A1 - Dumas, H. M. A1 - Fragala-Pinkham, M. A. KW - *Computer Simulation KW - *Disability Evaluation KW - Adolescent KW - Child KW - Child, Preschool KW - Cross-Sectional Studies KW - Disabled Children/*rehabilitation KW - Female KW - Humans KW - Infant KW - Male KW - Outcome Assessment (Health Care)/*methods KW - Rehabilitation Centers KW - Rehabilitation/*standards KW - Sensitivity and Specificity AB - 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'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. VL - 86 SN - 0003-9993 (Print) N1 - 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't, P.H.S.United StatesArchives of physical medicine and rehabilitationArch Phys Med Rehabil. 2005 May;86(5):932-9. ER - TY - JOUR T1 - Computer adaptive testing: a strategy for monitoring stroke rehabilitation across settings JF - Stroke Rehabilitation Y1 - 2004 A1 - Andres, P. L. A1 - Black-Schaffer, R. M. A1 - Ni, P. A1 - Haley, S. M. KW - *Computer Simulation KW - *User-Computer Interface KW - Adult KW - Aged KW - Aged, 80 and over KW - Cerebrovascular Accident/*rehabilitation KW - Disabled Persons/*classification KW - Female KW - Humans KW - Male KW - Middle Aged KW - Monitoring, Physiologic/methods KW - Severity of Illness Index KW - Task Performance and Analysis AB - 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'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. VL - 11 SN - 1074-9357 (Print) N1 - Andres, Patricia LBlack-Schaffer, Randie MNi, PengshengHaley, Stephen MR01 hd43568/hd/nichdEvaluation StudiesResearch Support, U.S. Gov't, Non-P.H.S.Research Support, U.S. Gov't, P.H.S.United StatesTopics in stroke rehabilitationTop Stroke Rehabil. 2004 Spring;11(2):33-9. ER - TY - JOUR T1 - Computerized adaptive measurement of depression: A simulation study JF - BMC Psychiatry Y1 - 2004 A1 - Gardner, W. A1 - Shear, K. A1 - Kelleher, K. J. A1 - Pajer, K. A. A1 - Mammen, O. A1 - Buysse, D. A1 - Frank, E. KW - *Computer Simulation KW - Adult KW - Algorithms KW - Area Under Curve KW - Comparative Study KW - Depressive Disorder/*diagnosis/epidemiology/psychology KW - Diagnosis, Computer-Assisted/*methods/statistics & numerical data KW - Factor Analysis, Statistical KW - Female KW - Humans KW - Internet KW - Male KW - Mass Screening/methods KW - Patient Selection KW - Personality Inventory/*statistics & numerical data KW - Pilot Projects KW - Prevalence KW - Psychiatric Status Rating Scales/*statistics & numerical data KW - Psychometrics KW - Research Support, Non-U.S. Gov't KW - Research Support, U.S. Gov't, P.H.S. KW - Severity of Illness Index KW - Software AB - 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. VL - 4 ER - TY - JOUR T1 - An examination of the comparative reliability, validity, and accuracy of performance ratings made using computerized adaptive rating scales JF - Journal of Applied Psychology Y1 - 2001 A1 - Borman, W. C. A1 - Buck, D. E. A1 - Hanson, M. A. A1 - Motowidlo, S. J. A1 - Stark, S. A1 - F Drasgow KW - *Computer Simulation KW - *Employee Performance Appraisal KW - *Personnel Selection KW - Adult KW - Automatic Data Processing KW - Female KW - Human KW - Male KW - Reproducibility of Results KW - Sensitivity and Specificity KW - Support, U.S. Gov't, Non-P.H.S. KW - Task Performance and Analysis KW - Video Recording AB - This laboratory research compared the reliability, validity, and accuracy of a computerized adaptive rating scale (CARS) format and 2 relatively common and representative rating formats. The CARS is a paired-comparison rating task that uses adaptive testing principles to present pairs of scaled behavioral statements to the rater to iteratively estimate a ratee's effectiveness on 3 dimensions of contextual performance. Videotaped vignettes of 6 office workers were prepared, depicting prescripted levels of contextual performance, and 112 subjects rated these vignettes using the CARS format and one or the other competing format. Results showed 23%-37% lower standard errors of measurement for the CARS format. In addition, validity was significantly higher for the CARS format (d = .18), and Cronbach's accuracy coefficients showed significantly higher accuracy, with a median effect size of .08. The discussion focuses on possible reasons for the results. VL - 86 N1 - 214803450021-9010Journal ArticleValidation Studies ER - TY - JOUR T1 - Methodologic trends in the healthcare professions: computer adaptive and computer simulation testing JF - Nurse Education Y1 - 1996 A1 - Forker, J. E. A1 - McDonald, M. E. KW - *Clinical Competence KW - *Computer Simulation KW - Computer-Assisted Instruction/*methods KW - Educational Measurement/*methods KW - Humans AB - 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'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'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. VL - 21 SN - 0363-3624 (Print)0363-3624 (Linking) N1 - Forker, J EMcDonald, M EUnited statesNurse educatorNurse Educ. 1996 Jul-Aug;21(4):13-4. ER -