TY - JOUR T1 - Development and preliminary testing of a computerized adaptive assessment of chronic pain JF - Journal of Pain Y1 - 2009 A1 - Anatchkova, M. D. A1 - Saris-Baglama, R. N. A1 - Kosinski, M. A1 - Bjorner, J. B. KW - *Computers KW - *Questionnaires KW - Activities of Daily Living KW - Adaptation, Psychological KW - Chronic Disease KW - Cohort Studies KW - Disability Evaluation KW - Female KW - Humans KW - Male KW - Middle Aged KW - Models, Psychological KW - Outcome Assessment (Health Care) KW - Pain Measurement/*methods KW - Pain, Intractable/*diagnosis/psychology KW - Psychometrics KW - Quality of Life KW - User-Computer Interface AB - 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'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' 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. VL - 10 SN - 1528-8447 (Electronic)1526-5900 (Linking) N1 - 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. U2 - 2763618 ER - TY - JOUR T1 - An evaluation of a patient-reported outcomes found computerized adaptive testing was efficient in assessing osteoarthritis impact JF - Journal of Clinical Epidemiology Y1 - 2006 A1 - Kosinski, M. A1 - Bjorner, J. A1 - Warejr, J. A1 - Sullivan, E. A1 - Straus, W. AB - BACKGROUND AND OBJECTIVES: Evaluate a patient-reported outcomes questionnaire that uses computerized adaptive testing (CAT) to measure the impact of osteoarthritis (OA) on functioning and well-being. MATERIALS AND METHODS: OA patients completed 37 questions about the impact of OA on physical, social and role functioning, emotional well-being, and vitality. Questionnaire responses were calibrated and scored using item response theory, and two scores were estimated: a Total-OA score based on patients' responses to all 37 questions, and a simulated CAT-OA score where the computer selected and scored the five most informative questions for each patient. Agreement between Total-OA and CAT-OA scores was assessed using correlations. Discriminant validity of Total-OA and CAT-OA scores was assessed with analysis of variance. Criterion measures included OA pain and severity, patient global assessment, and missed work days. RESULTS: Simulated CAT-OA and Total-OA scores correlated highly (r = 0.96). Both Total-OA and simulated CAT-OA scores discriminated significantly between patients differing on the criterion measures. F-statistics across criterion measures ranged from 39.0 (P < .001) to 225.1 (P < .001) for the Total-OA score, and from 40.5 (P < .001) to 221.5 (P < .001) for the simulated CAT-OA score. CONCLUSIONS: CAT methods produce valid and precise estimates of the impact of OA on functioning and well-being with significant reduction in response burden. VL - 59 SN - 08954356 ER - TY - CHAP T1 - Computerized adaptive testing and item banking Y1 - 2004 A1 - Bjorner, J. B. A1 - Kosinski, M. A1 - Ware, J. E A1 - Jr. CY - P. M. Fayers and R. D. Hays (Eds.) Assessing Quality of Life. Oxford: Oxford University Press. N1 - {PDF file 371 KB} ER - TY - JOUR T1 - Score comparability of short forms and computerized adaptive testing: Simulation study with the activity measure for post-acute care JF - Archives of Physical Medicine and Rehabilitation Y1 - 2004 A1 - Haley, S. M. A1 - Coster, W. J. A1 - Andres, P. L. A1 - Kosinski, M. A1 - Ni, P. KW - Boston KW - Factor Analysis, Statistical KW - Humans KW - Outcome Assessment (Health Care)/*methods KW - Prospective Studies KW - Questionnaires/standards KW - Rehabilitation/*standards KW - Subacute Care/*standards AB - 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'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. VL - 85 SN - 0003-9993 (Print) N1 - Haley, Stephen MCoster, Wendy JAndres, Patricia LKosinski, MarkNi, PengshengR01 hd43568/hd/nichdComparative StudyMulticenter StudyResearch Support, U.S. Gov't, Non-P.H.S.Research Support, U.S. Gov't, P.H.S.United StatesArchives of physical medicine and rehabilitationArch Phys Med Rehabil. 2004 Apr;85(4):661-6. ER - TY - JOUR T1 - Calibration of an item pool for assessing the burden of headaches: an application of item response theory to the Headache Impact Test (HIT) JF - Quality of Life Research Y1 - 2003 A1 - Bjorner, J. B. A1 - Kosinski, M. A1 - Ware, J. E., Jr. KW - *Cost of Illness KW - *Decision Support Techniques KW - *Sickness Impact Profile KW - Adolescent KW - Adult KW - Aged KW - Comparative Study KW - Disability Evaluation KW - Factor Analysis, Statistical KW - Headache/*psychology KW - Health Surveys KW - Human KW - Longitudinal Studies KW - Middle Aged KW - Migraine/psychology KW - Models, Psychological KW - Psychometrics/*methods KW - Quality of Life/*psychology KW - Software KW - Support, Non-U.S. Gov't AB - BACKGROUND: Measurement of headache impact is important in clinical trials, case detection, and the clinical monitoring of patients. Computerized adaptive testing (CAT) of headache impact has potential advantages over traditional fixed-length tests in terms of precision, relevance, real-time quality control and flexibility. OBJECTIVE: To develop an item pool that can be used for a computerized adaptive test of headache impact. METHODS: We analyzed responses to four well-known tests of headache impact from a population-based sample of recent headache sufferers (n = 1016). We used confirmatory factor analysis for categorical data and analyses based on item response theory (IRT). RESULTS: In factor analyses, we found very high correlations between the factors hypothesized by the original test constructers, both within and between the original questionnaires. These results suggest that a single score of headache impact is sufficient. We established a pool of 47 items which fitted the generalized partial credit IRT model. By simulating a computerized adaptive health test we showed that an adaptive test of only five items had a very high concordance with the score based on all items and that different worst-case item selection scenarios did not lead to bias. CONCLUSION: We have established a headache impact item pool that can be used in CAT of headache impact. VL - 12 N1 - 0962-9343Journal Article ER - TY - JOUR T1 - The feasibility of applying item response theory to measures of migraine impact: a re-analysis of three clinical studies JF - Quality of Life Research Y1 - 2003 A1 - Bjorner, J. B. A1 - Kosinski, M. A1 - Ware, J. E., Jr. KW - *Sickness Impact Profile KW - Adolescent KW - Adult KW - Aged KW - Comparative Study KW - Cost of Illness KW - Factor Analysis, Statistical KW - Feasibility Studies KW - Female KW - Human KW - Male KW - Middle Aged KW - Migraine/*psychology KW - Models, Psychological KW - Psychometrics/instrumentation/*methods KW - Quality of Life/*psychology KW - Questionnaires KW - Support, Non-U.S. Gov't AB - BACKGROUND: Item response theory (IRT) is a powerful framework for analyzing multiitem scales and is central to the implementation of computerized adaptive testing. OBJECTIVES: To explain the use of IRT to examine measurement properties and to apply IRT to a questionnaire for measuring migraine impact--the Migraine Specific Questionnaire (MSQ). METHODS: Data from three clinical studies that employed the MSQ-version 1 were analyzed by confirmatory factor analysis for categorical data and by IRT modeling. RESULTS: Confirmatory factor analyses showed very high correlations between the factors hypothesized by the original test constructions. Further, high item loadings on one common factor suggest that migraine impact may be adequately assessed by only one score. IRT analyses of the MSQ were feasible and provided several suggestions as to how to improve the items and in particular the response choices. Out of 15 items, 13 showed adequate fit to the IRT model. In general, IRT scores were strongly associated with the scores proposed by the original test developers and with the total item sum score. Analysis of response consistency showed that more than 90% of the patients answered consistently according to a unidimensional IRT model. For the remaining patients, scores on the dimension of emotional function were less strongly related to the overall IRT scores that mainly reflected role limitations. Such response patterns can be detected easily using response consistency indices. Analysis of test precision across score levels revealed that the MSQ was most precise at one standard deviation worse than the mean impact level for migraine patients that are not in treatment. Thus, gains in test precision can be achieved by developing items aimed at less severe levels of migraine impact. CONCLUSIONS: IRT proved useful for analyzing the MSQ. The approach warrants further testing in a more comprehensive item pool for headache impact that would enable computerized adaptive testing. VL - 12 N1 - 0962-9343Journal Article ER - TY - JOUR T1 - Response to Hays et al and McHorney and Cohen: Practical implications of item response theory and computerized adaptive testing: A brief summary of ongoing studies of widely used headache impact scales JF - Medical Care Y1 - 2000 A1 - Ware, J. E., Jr. A1 - Bjorner, J. B. A1 - Kosinski, M. VL - 38 ER - TY - JOUR T1 - Dynamic health assessments: The search for more practical and more precise outcomes measures JF - Quality of Life Newsletter Y1 - 1999 A1 - Ware, J. E., Jr. A1 - Bjorner, J. B. A1 - Kosinski, M. N1 - {PDF file, 75 KB} ER -