%0 Journal Article %J Quality of Life Research %D 2009 %T Measuring global physical health in children with cerebral palsy: Illustration of a multidimensional bi-factor model and computerized adaptive testing %A Haley, S. M. %A Ni, P. %A Dumas, H. M. %A Fragala-Pinkham, M. A. %A Hambleton, R. K. %A Montpetit, K. %A Bilodeau, N. %A Gorton, G. E. %A Watson, K. %A Tucker, C. A. %K *Computer Simulation %K *Health Status %K *Models, Statistical %K Adaptation, Psychological %K Adolescent %K Cerebral Palsy/*physiopathology %K Child %K Child, Preschool %K Factor Analysis, Statistical %K Female %K Humans %K Male %K Massachusetts %K Pennsylvania %K Questionnaires %K Young Adult %X 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. %B Quality of Life Research %7 2009/02/18 %V 18 %P 359-370 %8 Apr %@ 0962-9343 (Print)0962-9343 (Linking) %G eng %M 19221892 %2 2692519 %0 Journal Article %J Quality of Life Research %D 2009 %T Replenishing a computerized adaptive test of patient-reported daily activity functioning %A Haley, S. M. %A Ni, P. %A Jette, A. M. %A Tao, W. %A Moed, R. %A Meyers, D. %A Ludlow, L. H. %K *Activities of Daily Living %K *Disability Evaluation %K *Questionnaires %K *User-Computer Interface %K Adult %K Aged %K Cohort Studies %K Computer-Assisted Instruction %K Female %K Humans %K Male %K Middle Aged %K Outcome Assessment (Health Care)/*methods %X 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. %B Quality of Life Research %7 2009/03/17 %V 18 %P 461-71 %8 May %@ 0962-9343 (Print)0962-9343 (Linking) %G eng %M 19288222 %0 Journal Article %J American Journal of Physical Medicine and Rehabilitation %D 2008 %T Adaptive short forms for outpatient rehabilitation outcome assessment %A Jette, A. M. %A Haley, S. M. %A Ni, P. %A Moed, R. %K *Activities of Daily Living %K *Ambulatory Care Facilities %K *Mobility Limitation %K *Treatment Outcome %K Disabled Persons/psychology/*rehabilitation %K Female %K Humans %K Male %K Middle Aged %K Questionnaires %K Rehabilitation Centers %X 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' 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. %B American Journal of Physical Medicine and Rehabilitation %7 2008/09/23 %V 87 %P 842-52 %8 Oct %@ 1537-7385 (Electronic) %G eng %M 18806511 %0 Journal Article %J Archives of Physical Medicine and Rehabilitation %D 2008 %T Assessing self-care and social function using a computer adaptive testing version of the pediatric evaluation of disability inventory %A Coster, W. J. %A Haley, S. M. %A Ni, P. %A Dumas, H. M. %A Fragala-Pinkham, M. A. %K *Disability Evaluation %K *Social Adjustment %K Activities of Daily Living %K Adolescent %K Age Factors %K Child %K Child, Preschool %K Computer Simulation %K Cross-Over Studies %K Disabled Children/*rehabilitation %K Female %K Follow-Up Studies %K Humans %K Infant %K Male %K Outcome Assessment (Health Care) %K Reference Values %K Reproducibility of Results %K Retrospective Studies %K Risk Factors %K Self Care/*standards/trends %K Sex Factors %K Sickness Impact Profile %X 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'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. %B Archives of Physical Medicine and Rehabilitation %7 2008/04/01 %V 89 %P 622-629 %8 Apr %@ 1532-821X (Electronic)0003-9993 (Linking) %G eng %M 18373991 %2 2666276 %0 Journal Article %J Archives of Physical Medicine and Rehabilitation %D 2008 %T Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: II. Participation outcomes %A Haley, S. M. %A Gandek, B. %A Siebens, H. %A Black-Schaffer, R. M. %A Sinclair, S. J. %A Tao, W. %A Coster, W. J. %A Ni, P. %A Jette, A. M. %K *Activities of Daily Living %K *Adaptation, Physiological %K *Computer Systems %K *Questionnaires %K Adult %K Aged %K Aged, 80 and over %K Chi-Square Distribution %K Factor Analysis, Statistical %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Outcome Assessment (Health Care)/*methods %K Patient Discharge %K Prospective Studies %K Rehabilitation/*standards %K Subacute Care/*standards %X 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'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. %B Archives of Physical Medicine and Rehabilitation %7 2008/01/30 %V 89 %P 275-283 %8 Feb %@ 1532-821X (Electronic)0003-9993 (Linking) %G eng %M 18226651 %2 2666330 %0 Journal Article %J Journal of Pediatric Orthopedics %D 2008 %T Measuring physical functioning in children with spinal impairments with computerized adaptive testing %A Mulcahey, M. J. %A Haley, S. M. %A Duffy, T. %A Pengsheng, N. %A Betz, R. R. %K *Disability Evaluation %K Adolescent %K Child %K Child, Preschool %K Computer Simulation %K Cross-Sectional Studies %K Disabled Children/*rehabilitation %K Female %K Humans %K Infant %K Kyphosis/*diagnosis/rehabilitation %K Male %K Prospective Studies %K Reproducibility of Results %K Scoliosis/*diagnosis/rehabilitation %X 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. %B Journal of Pediatric Orthopedics %7 2008/03/26 %V 28 %P 330-5 %8 Apr-May %@ 0271-6798 (Print)0271-6798 (Linking) %G eng %M 18362799 %2 2696932 %0 Journal Article %J Journal of Clinical Epidemiology %D 2006 %T Computer adaptive testing improved accuracy and precision of scores over random item selection in a physical functioning item bank %A Haley, S. M. %A Ni, P. %A Hambleton, R. K. %A Slavin, M. D. %A Jette, A. M. %K *Recovery of Function %K Activities of Daily Living %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Confidence Intervals %K Factor Analysis, Statistical %K Female %K Humans %K Male %K Middle Aged %K Outcome Assessment (Health Care)/*methods %K Rehabilitation/*standards %K Reproducibility of Results %K Software %X 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. %B Journal of Clinical Epidemiology %7 2006/10/10 %V 59 %P 1174-82 %8 Nov %@ 0895-4356 (Print) %G eng %M 17027428 %0 Journal Article %J Archives of Physical Medicine and Rehabilitation %D 2006 %T Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: I. Activity outcomes %A Haley, S. M. %A Siebens, H. %A Coster, W. J. %A Tao, W. %A Black-Schaffer, R. M. %A Gandek, B. %A Sinclair, S. J. %A Ni, P. %K *Activities of Daily Living %K *Adaptation, Physiological %K *Computer Systems %K *Questionnaires %K Adult %K Aged %K Aged, 80 and over %K Chi-Square Distribution %K Factor Analysis, Statistical %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Outcome Assessment (Health Care)/*methods %K Patient Discharge %K Prospective Studies %K Rehabilitation/*standards %K Subacute Care/*standards %X 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' 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' 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. %B Archives of Physical Medicine and Rehabilitation %7 2006/08/01 %V 87 %P 1033-42 %8 Aug %@ 0003-9993 (Print) %G eng %M 16876547 %0 Journal Article %J Archives of Physical Medicine and Rehabilitation %D 2005 %T Assessing mobility in children using a computer adaptive testing version of the pediatric evaluation of disability inventory %A Haley, S. M. %A Raczek, A. E. %A Coster, W. J. %A Dumas, H. M. %A Fragala-Pinkham, M. A. %K *Computer Simulation %K *Disability Evaluation %K Adolescent %K Child %K Child, Preschool %K Cross-Sectional Studies %K Disabled Children/*rehabilitation %K Female %K Humans %K Infant %K Male %K Outcome Assessment (Health Care)/*methods %K Rehabilitation Centers %K Rehabilitation/*standards %K Sensitivity and Specificity %X 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. %B Archives of Physical Medicine and Rehabilitation %7 2005/05/17 %V 86 %P 932-9 %8 May %@ 0003-9993 (Print) %G eng %M 15895339 %0 Journal Article %J Developmental Medicine and Child Neuropsychology %D 2005 %T A computer adaptive testing approach for assessing physical functioning in children and adolescents %A Haley, S. M. %A Ni, P. %A Fragala-Pinkham, M. A. %A Skrinar, A. M. %A Corzo, D. %K *Computer Systems %K Activities of Daily Living %K Adolescent %K Age Factors %K Child %K Child Development/*physiology %K Child, Preschool %K Computer Simulation %K Confidence Intervals %K Demography %K Female %K Glycogen Storage Disease Type II/physiopathology %K Health Status Indicators %K Humans %K Infant %K Infant, Newborn %K Male %K Motor Activity/*physiology %K Outcome Assessment (Health Care)/*methods %K Reproducibility of Results %K Self Care %K Sensitivity and Specificity %X 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'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. %B Developmental Medicine and Child Neuropsychology %7 2005/02/15 %V 47 %P 113-120 %8 Feb %@ 0012-1622 (Print) %G eng %M 15707234 %0 Journal Article %J American Journal of Physical Medicine and Rehabilitation %D 2005 %T Measuring physical function in patients with complex medical and postsurgical conditions: a computer adaptive approach %A Siebens, H. %A Andres, P. L. %A Pengsheng, N. %A Coster, W. J. %A Haley, S. M. %K Activities of Daily Living/*classification %K Adult %K Aged %K Cohort Studies %K Continuity of Patient Care %K Disability Evaluation %K Female %K Health Services Research %K Humans %K Male %K Middle Aged %K Postoperative Care/*rehabilitation %K Prognosis %K Recovery of Function %K Rehabilitation Centers %K Rehabilitation/*standards %K Sensitivity and Specificity %K Sickness Impact Profile %K Treatment Outcome %X 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. %B American Journal of Physical Medicine and Rehabilitation %V 84 %P 741-8 %8 Oct %G eng %M 16205429 %0 Journal Article %J Medical Care %D 2004 %T Activity outcome measurement for postacute care %A Haley, S. M. %A Coster, W. J. %A Andres, P. L. %A Ludlow, L. H. %A Ni, P. %A Bond, T. L. %A Sinclair, S. J. %A Jette, A. M. %K *Self Efficacy %K *Sickness Impact Profile %K Activities of Daily Living/*classification/psychology %K Adult %K Aftercare/*standards/statistics & numerical data %K Aged %K Boston %K Cognition/physiology %K Disability Evaluation %K Factor Analysis, Statistical %K Female %K Human %K Male %K Middle Aged %K Movement/physiology %K Outcome Assessment (Health Care)/*methods/statistics & numerical data %K Psychometrics %K Questionnaires/standards %K Rehabilitation/*standards/statistics & numerical data %K Reproducibility of Results %K Sensitivity and Specificity %K Support, U.S. Gov't, Non-P.H.S. %K Support, U.S. Gov't, P.H.S. %X BACKGROUND: Efforts to evaluate the effectiveness of a broad range of postacute care services have been hindered by the lack of conceptually sound and comprehensive measures of outcomes. It is critical to determine a common underlying structure before employing current methods of item equating across outcome instruments for future item banking and computer-adaptive testing applications. OBJECTIVE: To investigate the factor structure, reliability, and scale properties of items underlying the Activity domains of the International Classification of Functioning, Disability and Health (ICF) for use in postacute care outcome measurement. METHODS: We developed a 41-item Activity Measure for Postacute Care (AM-PAC) that assessed an individual's execution of discrete daily tasks in his or her own environment across major content domains as defined by the ICF. We evaluated the reliability and discriminant validity of the prototype AM-PAC in 477 individuals in active rehabilitation programs across 4 rehabilitation settings using factor analyses, tests of item scaling, internal consistency reliability analyses, Rasch item response theory modeling, residual component analysis, and modified parallel analysis. RESULTS: Results from an initial exploratory factor analysis produced 3 distinct, interpretable factors that accounted for 72% of the variance: Applied Cognition (44%), Personal Care & Instrumental Activities (19%), and Physical & Movement Activities (9%); these 3 activity factors were verified by a confirmatory factor analysis. Scaling assumptions were met for each factor in the total sample and across diagnostic groups. Internal consistency reliability was high for the total sample (Cronbach alpha = 0.92 to 0.94), and for specific diagnostic groups (Cronbach alpha = 0.90 to 0.95). Rasch scaling, residual factor, differential item functioning, and modified parallel analyses supported the unidimensionality and goodness of fit of each unique activity domain. CONCLUSIONS: This 3-factor model of the AM-PAC can form the conceptual basis for common-item equating and computer-adaptive applications, leading to a comprehensive system of outcome instruments for postacute care settings. %B Medical Care %V 42 %P I49-161 %G eng %M 14707755 %0 Journal Article %J Stroke Rehabilitation %D 2004 %T Computer adaptive testing: a strategy for monitoring stroke rehabilitation across settings %A Andres, P. L. %A Black-Schaffer, R. M. %A Ni, P. %A Haley, S. M. %K *Computer Simulation %K *User-Computer Interface %K Adult %K Aged %K Aged, 80 and over %K Cerebrovascular Accident/*rehabilitation %K Disabled Persons/*classification %K Female %K Humans %K Male %K Middle Aged %K Monitoring, Physiologic/methods %K Severity of Illness Index %K Task Performance and Analysis %X 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. %B Stroke Rehabilitation %7 2004/05/01 %V 11 %P 33-39 %8 Spring %@ 1074-9357 (Print) %G eng %M 15118965 %0 Journal Article %J Medical Care %D 2004 %T Refining the conceptual basis for rehabilitation outcome measurement: personal care and instrumental activities domain %A Coster, W. J. %A Haley, S. M. %A Andres, P. L. %A Ludlow, L. H. %A Bond, T. L. %A Ni, P. S. %K *Self Efficacy %K *Sickness Impact Profile %K Activities of Daily Living/*classification/psychology %K Adult %K Aged %K Aged, 80 and over %K Disability Evaluation %K Factor Analysis, Statistical %K Female %K Humans %K Male %K Middle Aged %K Outcome Assessment (Health Care)/*methods/statistics & numerical data %K Questionnaires/*standards %K Recovery of Function/physiology %K Rehabilitation/*standards/statistics & numerical data %K Reproducibility of Results %K Research Support, U.S. Gov't, Non-P.H.S. %K Research Support, U.S. Gov't, P.H.S. %K Sensitivity and Specificity %X 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. %B Medical Care %V 42 %P I62-172 %8 Jan %G eng %M 14707756