%0 Generic %D 2011 %T Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): depression, anxiety, and anger %A Pilkonis, P. A. %A Choi, S. W. %A Reise, S. P. %A Stover, A. M. %A Riley, W. T. %A Cella, D. %B Assessment %@ 1073-1911 %G eng %& June 21, 2011 %0 Journal Article %J Quality of Life Research %D 2010 %T Efficiency of static and computer adaptive short forms compared to full-length measures of depressive symptoms %A Choi, S. %A Reise, S. P. %A Pilkonis, P. A. %A Hays, R. D. %A Cella, D. %B Quality of Life Research %V 19(1) %P 125–136 %G eng %0 Journal Article %J Journal of Applied Measurement %D 2010 %T The use of PROMIS and assessment center to deliver patient-reported outcome measures in clinical research %A Gershon, R. C. %A Rothrock, N. %A Hanrahan, R. %A Bass, M. %A Cella, D. %X The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed as one of the first projects funded by the NIH Roadmap for Medical Research Initiative to re-engineer the clinical research enterprise. The primary goal of PROMIS is to build item banks and short forms that measure key health outcome domains that are manifested in a variety of chronic diseases which could be used as a "common currency" across research projects. To date, item banks, short forms and computerized adaptive tests (CAT) have been developed for 13 domains with relevance to pediatric and adult subjects. To enable easy delivery of these new instruments, PROMIS built a web-based resource (Assessment Center) for administering CATs and other self-report data, tracking item and instrument development, monitoring accrual, managing data, and storing statistical analysis results. Assessment Center can also be used to deliver custom researcher developed content, and has numerous features that support both simple and complicated accrual designs (branching, multiple arms, multiple time points, etc.). This paper provides an overview of the development of the PROMIS item banks and details Assessment Center functionality. %B Journal of Applied Measurement %V 11 %P 304-314 %@ 1529-7713 %G eng %0 Journal Article %J Journal of Rheumatology %D 2009 %T Progress in assessing physical function in arthritis: PROMIS short forms and computerized adaptive testing %A Fries, J.F. %A Cella, D. %A Rose, M. %A Krishnan, E. %A Bruce, B. %K *Disability Evaluation %K *Outcome Assessment (Health Care) %K Arthritis/diagnosis/*physiopathology %K Health Surveys %K Humans %K Prognosis %K Reproducibility of Results %X 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. %B Journal of Rheumatology %7 2009/09/10 %V 36 %P 2061-2066 %8 Sep %@ 0315-162X (Print)0315-162X (Linking) %G eng %M 19738214 %0 Journal Article %J Quality of Life Research %D 2007 %T The future of outcomes measurement: item banking, tailored short-forms, and computerized adaptive assessment %A Cella, D. %A Gershon, R. C. %A Lai, J-S. %A Choi, S. W. %X The use of item banks and computerized adaptive testing (CAT) begins with clear definitions of important outcomes, and references those definitions to specific questions gathered into large and well-studied pools, or “banks” of items. Items can be selected from the bank to form customized short scales, or can be administered in a sequence and length determined by a computer programmed for precision and clinical relevance. Although far from perfect, such item banks can form a common definition and understanding of human symptoms and functional problems such as fatigue, pain, depression, mobility, social function, sensory function, and many other health concepts that we can only measure by asking people directly. The support of the National Institutes of Health (NIH), as witnessed by its cooperative agreement with measurement experts through the NIH Roadmap Initiative known as PROMIS (www.nihpromis.org), is a big step in that direction. Our approach to item banking and CAT is practical; as focused on application as it is on science or theory. From a practical perspective, we frequently must decide whether to re-write and retest an item, add more items to fill gaps (often at the ceiling of the measure), re-test a bank after some modifications, or split up a bank into units that are more unidimensional, yet less clinically relevant or complete. These decisions are not easy, and yet they are rarely unforgiving. We encourage people to build practical tools that are capable of producing multiple short form measures and CAT administrations from common banks, and to further our understanding of these banks with various clinical populations and ages, so that with time the scores that emerge from these many activities begin to have not only a common metric and range, but a shared meaning and understanding across users. In this paper, we provide an overview of item banking and CAT, discuss our approach to item banking and its byproducts, describe testing options, discuss an example of CAT for fatigue, and discuss models for long term sustainability of an entity such as PROMIS. Some barriers to success include limitations in the methods themselves, controversies and disagreements across approaches, and end-user reluctance to move away from the familiar. %B Quality of Life Research %V 16 %P 133-141 %@ 0962-9343 %G eng %0 Journal Article %J Quality of Life Research %D 2007 %T IRT health outcomes data analysis project: an overview and summary %A Cook, K. F. %A Teal, C. R. %A Bjorner, J. B. %A Cella, D. %A Chang, C-H. %A Crane, P. K. %A Gibbons, L. E. %A Hays, R. D. %A McHorney, C. A. %A Ocepek-Welikson, K. %A Raczek, A. E. %A Teresi, J. A. %A Reeve, B. B. %K *Data Interpretation, Statistical %K *Health Status %K *Quality of Life %K *Questionnaires %K *Software %K Female %K HIV Infections/psychology %K Humans %K Male %K Neoplasms/psychology %K Outcome Assessment (Health Care)/*methods %K Psychometrics %K Stress, Psychological %X 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. %B Quality of Life Research %7 2007/03/14 %V 16 %P 121-132 %@ 0962-9343 (Print) %G eng %M 17351824 %0 Journal Article %J Medical Care %D 2007 %T The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years %A Cella, D. %A Yount, S. %A Rothrock, N. %A Gershon, R. C. %A Cook, K. F. %A Reeve, B. %A Ader, D. %A Fries, J.F. %A Bruce, B. %A Rose, M. %X The National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Roadmap initiative (www.nihpromis.org) is a 5-year cooperative group program of research designed to develop, validate, and standardize item banks to measure patient-reported outcomes (PROs) relevant across common medical conditions. In this article, we will summarize the organization and scientific activity of the PROMIS network during its first 2 years. %B Medical Care %V 45 %P S3-S11 %G eng %0 Journal Article %J Medical Care %D 2007 %T Psychometric evaluation and calibration of health-related quality of life item banks: plans for the Patient-Reported Outcomes Measurement Information System (PROMIS) %A Reeve, B. B. %A Hays, R. D. %A Bjorner, J. B. %A Cook, K. F. %A Crane, P. K. %A Teresi, J. A. %A Thissen, D. %A Revicki, D. A. %A Weiss, D. J. %A Hambleton, R. K. %A Liu, H. %A Gershon, R. C. %A Reise, S. P. %A Lai, J. S. %A Cella, D. %K *Health Status %K *Information Systems %K *Quality of Life %K *Self Disclosure %K Adolescent %K Adult %K Aged %K Calibration %K Databases as Topic %K Evaluation Studies as Topic %K Female %K Humans %K Male %K Middle Aged %K Outcome Assessment (Health Care)/*methods %K Psychometrics %K Questionnaires/standards %K United States %X 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. %B Medical Care %7 2007/04/20 %V 45 %P S22-31 %8 May %@ 0025-7079 (Print) %G eng %M 17443115 %0 Journal Article %J Journal of Applied Measurement %D 2006 %T Expansion of a physical function item bank and development of an abbreviated form for clinical research %A Bode, R. K. %A Lai, J-S. %A Dineen, K. %A Heinemann, A. W. %A Shevrin, D. %A Von Roenn, J. %A Cella, D. %K clinical research %K computerized adaptive testing %K performance levels %K physical function item bank %K Psychometrics %K test reliability %K Test Validity %X We expanded an existing 33-item physical function (PF) item bank with a sufficient number of items to enable computerized adaptive testing (CAT). Ten items were written to expand the bank and the new item pool was administered to 295 people with cancer. For this analysis of the new pool, seven poorly performing items were identified for further examination. This resulted in a bank with items that define an essentially unidimensional PF construct, cover a wide range of that construct, reliably measure the PF of persons with cancer, and distinguish differences in self-reported functional performance levels. We also developed a 5-item (static) assessment form ("BriefPF") that can be used in clinical research to express scores on the same metric as the overall bank. The BriefPF was compared to the PF-10 from the Medical Outcomes Study SF-36. Both short forms significantly differentiated persons across functional performance levels. While the entire bank was more precise across the PF continuum than either short form, there were differences in the area of the continuum in which each short form was more precise: the BriefPF was more precise than the PF-10 at the lower functional levels and the PF-10 was more precise than the BriefPF at the higher levels. Future research on this bank will include the development of a CAT version, the PF-CAT. (PsycINFO Database Record (c) 2007 APA, all rights reserved) %B Journal of Applied Measurement %I Richard M Smith: US %V 7 %P 1-15 %@ 1529-7713 (Print) %G eng %M 2006-01262-001 %0 Journal Article %J Quality of Life Research %D 2006 %T Factor analysis techniques for assessing sufficient unidimensionality of cancer related fatigue %A Lai, J-S. %A Crane, P. K. %A Cella, D. %K *Factor Analysis, Statistical %K *Quality of Life %K Aged %K Chicago %K Fatigue/*etiology %K Female %K Humans %K Male %K Middle Aged %K Neoplasms/*complications %K Questionnaires %X 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. %B Quality of Life Research %V 15 %P 1179-90 %8 Sep %G eng %M 17001438 %0 Journal Article %J Medical Care %D 2006 %T Item banks and their potential applications to health status assessment in diverse populations %A Hahn, E. A. %A Cella, D. %A Bode, R. K. %A Gershon, R. C. %A Lai, J. S. %X In the context of an ethnically diverse, aging society, attention is increasingly turning to health-related quality of life measurement to evaluate healthcare and treatment options for chronic diseases. When evaluating and treating symptoms and concerns such as fatigue, pain, or physical function, reliable and accurate assessment is a priority. Modern psychometric methods have enabled us to move from long, static tests that provide inefficient and often inaccurate assessment of individual patients, to computerized adaptive tests (CATs) that can precisely measure individuals on health domains of interest. These modern methods, collectively referred to as item response theory (IRT), can produce calibrated "item banks" from larger pools of questions. From these banks, CATs can be conducted on individuals to produce their scores on selected domains. Item banks allow for comparison of patients across different question sets because the patient's score is expressed on a common scale. Other advantages of using item banks include flexibility in terms of the degree of precision desired; interval measurement properties under most circumstances; realistic capability for accurate individual assessment over time (using CAT); and measurement equivalence across different patient populations. This work summarizes the process used in the creation and evaluation of item banks and reviews their potential contributions and limitations regarding outcome assessment and patient care, particularly when they are applied across people of different cultural backgrounds. %B Medical Care %V 44 %P S189-S197 %8 Nov %G eng %M 17060827 %0 Journal Article %J Evaluation and the Health Professions %D 2005 %T Data pooling and analysis to build a preliminary item bank: an example using bowel function in prostate cancer %A Eton, D. T. %A Lai, J. S. %A Cella, D. %A Reeve, B. B. %A Talcott, J. A. %A Clark, J. A. %A McPherson, C. P. %A Litwin, M. S. %A Moinpour, C. M. %K *Quality of Life %K *Questionnaires %K Adult %K Aged %K Data Collection/methods %K Humans %K Intestine, Large/*physiopathology %K Male %K Middle Aged %K Prostatic Neoplasms/*physiopathology %K Psychometrics %K Research Support, Non-U.S. Gov't %K Statistics, Nonparametric %X 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. %B Evaluation and the Health Professions %V 28 %P 142-59 %G eng %M 15851770 %0 Journal Article %J Journal of Clinical Epidemiology %D 2005 %T An item bank was created to improve the measurement of cancer-related fatigue %A Lai, J-S. %A Cella, D. %A Dineen, K. %A Bode, R. %A Von Roenn, J. %A Gershon, R. C. %A Shevrin, D. %K Adult %K Aged %K Aged, 80 and over %K Factor Analysis, Statistical %K Fatigue/*etiology/psychology %K Female %K Humans %K Male %K Middle Aged %K Neoplasms/*complications/psychology %K Psychometrics %K Questionnaires %X 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. %B Journal of Clinical Epidemiology %7 2005/02/01 %V 58 %P 190-7 %8 Feb %@ 0895-4356 (Print)0895-4356 (Linking) %G eng %9 Multicenter Study %M 15680754 %0 Journal Article %J Journal of Pain and Symptom Management %D 2005 %T An item response theory-based pain item bank can enhance measurement precision %A Lai, J-S. %A Dineen, K. %A Reeve, B. B. %A Von Roenn, J. %A Shervin, D. %A McGuire, M. %A Bode, R. K. %A Paice, J. %A Cella, D. %K computerized adaptive testing %X Cancer-related pain is often under-recognized and undertreated. This is partly due to the lack of appropriate assessments, which need to be comprehensive and precise yet easily integrated into clinics. Computerized adaptive testing (CAT) can enable precise-yet-brief assessments by only selecting the most informative items from a calibrated item bank. The purpose of this study was to create such a bank. The sample included 400 cancer patients who were asked to complete 61 pain-related items. Data were analyzed using factor analysis and the Rasch model. The final bank consisted of 43 items which satisfied the measurement requirement of factor analysis and the Rasch model, demonstrated high internal consistency and reasonable item-total correlations, and discriminated patients with differing degrees of pain. We conclude that this bank demonstrates good psychometric properties, is sensitive to pain reported by patients, and can be used as the foundation for a CAT pain-testing platform for use in clinical practice. %B Journal of Pain and Symptom Management %V 30 %P 278-88 %G eng %M 16183012 %0 Journal Article %J Clinical and Experimental Rheumatology %D 2005 %T The promise of PROMIS: using item response theory to improve assessment of patient-reported outcomes %A Fries, J.F. %A Bruce, B. %A Cella, D. %K computerized adaptive testing %X PROMIS (Patient-Reported-Outcomes Measurement Information System) is an NIH Roadmap network project intended to improve the reliability, validity, and precision of PROs and to provide definitive new instruments that will exceed the capabilities of classic instruments and enable improved outcome measurement for clinical research across all NIH institutes. Item response theory (IRT) measurement models now permit us to transition conventional health status assessment into an era of item banking and computerized adaptive testing (CAT). Item banking uses IRT measurement models and methods to develop item banks from large pools of items from many available questionnaires. IRT allows the reduction and improvement of items and assembles domains of items which are unidimensional and not excessively redundant. CAT provides a model-driven algorithm and software to iteratively select the most informative remaining item in a domain until a desired degree of precision is obtained. Through these approaches the number of patients required for a clinical trial may be reduced while holding statistical power constant. PROMIS tools, expected to improve precision and enable assessment at the individual patient level which should broaden the appeal of PROs, will begin to be available to the general medical community in 2008. %B Clinical and Experimental Rheumatology %V 23 %P S53-7 %G eng %M 16273785 %0 Journal Article %J Clinical Therapeutics %D 2003 %T Can an item response theory-based pain item bank enhance measurement precision? %A Lai, J-S. %A Dineen, K. %A Cella, D. %A Von Roenn, J. %B Clinical Therapeutics %V 25 %P D34-D36 %G eng %M 14568660 %! Clin Ther %0 Journal Article %J Journal of Applied Measurement %D 2003 %T Developing an initial physical function item bank from existing sources %A Bode, R. K. %A Cella, D. %A Lai, J. S. %A Heinemann, A. W. %K *Databases %K *Sickness Impact Profile %K Adaptation, Psychological %K Data Collection %K Humans %K Neoplasms/*physiopathology/psychology/therapy %K Psychometrics %K Quality of Life/*psychology %K Research Support, U.S. Gov't, P.H.S. %K United States %X 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. %B Journal of Applied Measurement %V 4 %P 124-36 %G eng %M 12748405 %0 Journal Article %J Quality of Life Research %D 2003 %T 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 %A Lai, J-S. %A Crane, P. K. %A Cella, D. %A Chang, C-H. %A Bode, R. K. %A Heinemann, A. W. %K *Health Status Indicators %K *Questionnaires %K Adult %K Fatigue/*diagnosis/etiology %K Female %K Humans %K Male %K Middle Aged %K Neoplasms/complications %K Psychometrics %K Research Support, Non-U.S. Gov't %K Research Support, U.S. Gov't, P.H.S. %K Sickness Impact Profile %X 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'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. %B Quality of Life Research %V 12 %P 485-501 %8 Aug %G eng %M 13677494 %0 Journal Article %J Seminars in Oncology %D 2002 %T Advances in quality of life measurements in oncology patients %A Cella, D. %A Chang, C-H. %A Lai, J. S. %A Webster, K. %K *Quality of Life %K *Sickness Impact Profile %K Cross-Cultural Comparison %K Culture %K Humans %K Language %K Neoplasms/*physiopathology %K Questionnaires %X 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'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. %B Seminars in Oncology %V 29 %P 60-8 %8 Jun %G eng %M 12082656 %0 Journal Article %J Quality of Life Research %D 2002 %T Feasibility and acceptability of computerized adaptive testing (CAT) for fatigue monitoring in clinical practice %A Davis, K. M. %A Chang, C-H. %A Lai, J-S. %A Cella, D. %B Quality of Life Research %V 11(7) %P 134 %G eng %0 Journal Article %J Archives of Physical Medicine and Rehabilitation %D 2002 %T Measuring quality of life in chronic illness: the functional assessment of chronic illness therapy measurement system %A Cella, D. %A Nowinski, C. J. %K *Chronic Disease %K *Quality of Life %K *Rehabilitation %K Adult %K Comparative Study %K Health Status Indicators %K Humans %K Psychometrics %K Questionnaires %K Research Support, U.S. Gov't, P.H.S. %K Sensitivity and Specificity %X 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. %B Archives of Physical Medicine and Rehabilitation %V 83 %P S10-7 %8 Dec %G eng %M 12474167