%0 Journal Article %J Sleep %D 2010 %T Development and validation of patient-reported outcome measures for sleep disturbance and sleep-related impairments %A Buysse, D. J. %A Yu, L. %A Moul, D. E. %A Germain, A. %A Stover, A. %A Dodds, N. E. %A Johnston, K. L. %A Shablesky-Cade, M. A. %A Pilkonis, P. A. %K *Outcome Assessment (Health Care) %K *Self Disclosure %K Adult %K Aged %K Aged, 80 and over %K Cross-Sectional Studies %K Factor Analysis, Statistical %K Female %K Humans %K Male %K Middle Aged %K Psychometrics %K Questionnaires %K Reproducibility of Results %K Sleep Disorders/*diagnosis %K Young Adult %X STUDY OBJECTIVES: To develop an archive of self-report questions assessing sleep disturbance and sleep-related impairments (SRI), to develop item banks from this archive, and to validate and calibrate the item banks using classic validation techniques and item response theory analyses in a sample of clinical and community participants. DESIGN: Cross-sectional self-report study. SETTING: Academic medical center and participant homes. PARTICIPANTS: One thousand nine hundred ninety-three adults recruited from an Internet polling sample and 259 adults recruited from medical, psychiatric, and sleep clinics. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: This study was part of PROMIS (Patient-Reported Outcomes Information System), a National Institutes of Health Roadmap initiative. Self-report item banks were developed through an iterative process of literature searches, collecting and sorting items, expert content review, qualitative patient research, and pilot testing. Internal consistency, convergent validity, and exploratory and confirmatory factor analysis were examined in the resulting item banks. Factor analyses identified 2 preliminary item banks, sleep disturbance and SRI. Item response theory analyses and expert content review narrowed the item banks to 27 and 16 items, respectively. Validity of the item banks was supported by moderate to high correlations with existing scales and by significant differences in sleep disturbance and SRI scores between participants with and without sleep disorders. CONCLUSIONS: The PROMIS sleep disturbance and SRI item banks have excellent measurement properties and may prove to be useful for assessing general aspects of sleep and SRI with various groups of patients and interventions. %B Sleep %7 2010/06/17 %V 33 %P 781-92 %8 Jun 1 %@ 0161-8105 (Print)0161-8105 (Linking) %G eng %M 20550019 %2 2880437 %0 Journal Article %J Journal of Clinical Epidemiology %D 2009 %T An evaluation of patient-reported outcomes found computerized adaptive testing was efficient in assessing stress perception %A Kocalevent, R. D. %A Rose, M. %A Becker, J. %A Walter, O. B. %A Fliege, H. %A Bjorner, J. B. %A Kleiber, D. %A Klapp, B. F. %K *Diagnosis, Computer-Assisted %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Confidence Intervals %K Female %K Humans %K Male %K Middle Aged %K Perception %K Quality of Health Care/*standards %K Questionnaires %K Reproducibility of Results %K Sickness Impact Profile %K Stress, Psychological/*diagnosis/psychology %K Treatment Outcome %X OBJECTIVES: This study aimed to develop and evaluate a first computerized adaptive test (CAT) for the measurement of stress perception (Stress-CAT), in terms of the two dimensions: exposure to stress and stress reaction. STUDY DESIGN AND SETTING: Item response theory modeling was performed using a two-parameter model (Generalized Partial Credit Model). The evaluation of the Stress-CAT comprised a simulation study and real clinical application. A total of 1,092 psychosomatic patients (N1) were studied. Two hundred simulees (N2) were generated for a simulated response data set. Then the Stress-CAT was given to n=116 inpatients, (N3) together with established stress questionnaires as validity criteria. RESULTS: The final banks included n=38 stress exposure items and n=31 stress reaction items. In the first simulation study, CAT scores could be estimated with a high measurement precision (SE<0.32; rho>0.90) using 7.0+/-2.3 (M+/-SD) stress reaction items and 11.6+/-1.7 stress exposure items. The second simulation study reanalyzed real patients data (N1) and showed an average use of items of 5.6+/-2.1 for the dimension stress reaction and 10.0+/-4.9 for the dimension stress exposure. Convergent validity showed significantly high correlations. CONCLUSIONS: The Stress-CAT is short and precise, potentially lowering the response burden of patients in clinical decision making. %B Journal of Clinical Epidemiology %7 2008/07/22 %V 62 %P 278-287 %@ 1878-5921 (Electronic)0895-4356 (Linking) %G eng %M 18639439 %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 Spine %D 2008 %T Letting the CAT out of the bag: Comparing computer adaptive tests and an 11-item short form of the Roland-Morris Disability Questionnaire %A Cook, K. F. %A Choi, S. W. %A Crane, P. K. %A Deyo, R. A. %A Johnson, K. L. %A Amtmann, D. %K *Disability Evaluation %K *Health Status Indicators %K Adult %K Aged %K Aged, 80 and over %K Back Pain/*diagnosis/psychology %K Calibration %K Computer Simulation %K Diagnosis, Computer-Assisted/*standards %K Humans %K Middle Aged %K Models, Psychological %K Predictive Value of Tests %K Questionnaires/*standards %K Reproducibility of Results %X STUDY DESIGN: A post hoc simulation of a computer adaptive administration of the items of a modified version of the Roland-Morris Disability Questionnaire. OBJECTIVE: To evaluate the effectiveness of adaptive administration of back pain-related disability items compared with a fixed 11-item short form. SUMMARY OF BACKGROUND DATA: Short form versions of the Roland-Morris Disability Questionnaire have been developed. An alternative to paper-and-pencil short forms is to administer items adaptively so that items are presented based on a person's responses to previous items. Theoretically, this allows precise estimation of back pain disability with administration of only a few items. MATERIALS AND METHODS: Data were gathered from 2 previously conducted studies of persons with back pain. An item response theory model was used to calibrate scores based on all items, items of a paper-and-pencil short form, and several computer adaptive tests (CATs). RESULTS: Correlations between each CAT condition and scores based on a 23-item version of the Roland-Morris Disability Questionnaire ranged from 0.93 to 0.98. Compared with an 11-item short form, an 11-item CAT produced scores that were significantly more highly correlated with scores based on the 23-item scale. CATs with even fewer items also produced scores that were highly correlated with scores based on all items. For example, scores from a 5-item CAT had a correlation of 0.93 with full scale scores. Seven- and 9-item CATs correlated at 0.95 and 0.97, respectively. A CAT with a standard-error-based stopping rule produced scores that correlated at 0.95 with full scale scores. CONCLUSION: A CAT-based back pain-related disability measure may be a valuable tool for use in clinical and research contexts. Use of CAT for other common measures in back pain research, such as other functional scales or measures of psychological distress, may offer similar advantages. %B Spine %7 2008/05/23 %V 33 %P 1378-83 %8 May 20 %@ 1528-1159 (Electronic) %G eng %M 18496352 %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 Journal of Clinical Epidemiology %D 2006 %T Simulated computerized adaptive test for patients with shoulder impairments was efficient and produced valid measures of function %A Hart, D. L. %A Cook, K. F. %A Mioduski, J. E. %A Teal, C. R. %A Crane, P. K. %K *Computer Simulation %K *Range of Motion, Articular %K Activities of Daily Living %K Adult %K Aged %K Aged, 80 and over %K Factor Analysis, Statistical %K Female %K Humans %K Male %K Middle Aged %K Prospective Studies %K Reproducibility of Results %K Research Support, N.I.H., Extramural %K Research Support, U.S. Gov't, Non-P.H.S. %K Shoulder Dislocation/*physiopathology/psychology/rehabilitation %K Shoulder Pain/*physiopathology/psychology/rehabilitation %K Shoulder/*physiopathology %K Sickness Impact Profile %K Treatment Outcome %X 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. %B Journal of Clinical Epidemiology %V 59 %P 290-8 %G eng %M 16488360 %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 Clinical Epidemiology %D 2005 %T Simulated computerized adaptive tests for measuring functional status were efficient with good discriminant validity in patients with hip, knee, or foot/ankle impairments %A Hart, D. L. %A Mioduski, J. E. %A Stratford, P. W. %K *Health Status Indicators %K Activities of Daily Living %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Ankle Joint/physiopathology %K Diagnosis, Computer-Assisted/*methods %K Female %K Hip Joint/physiopathology %K Humans %K Joint Diseases/physiopathology/*rehabilitation %K Knee Joint/physiopathology %K Lower Extremity/*physiopathology %K Male %K Middle Aged %K Research Support, N.I.H., Extramural %K Research Support, U.S. Gov't, P.H.S. %K Retrospective Studies %X BACKGROUND AND OBJECTIVE: To develop computerized adaptive tests (CATs) designed to assess lower extremity functional status (FS) in people with lower extremity impairments using items from the Lower Extremity Functional Scale and compare discriminant validity of FS measures generated using all items analyzed with a rating scale Item Response Theory model (theta(IRT)) and measures generated using the simulated CATs (theta(CAT)). METHODS: Secondary analysis of retrospective intake rehabilitation data. RESULTS: Unidimensionality of items was strong, and local independence of items was adequate. Differential item functioning (DIF) affected item calibration related to body part, that is, hip, knee, or foot/ankle, but DIF did not affect item calibration for symptom acuity, gender, age, or surgical history. Therefore, patients were separated into three body part specific groups. The rating scale model fit all three data sets well. Three body part specific CATs were developed: each was 70% more efficient than using all LEFS items to estimate FS measures. theta(IRT) and theta(CAT) measures discriminated patients by symptom acuity, age, and surgical history in similar ways. theta(CAT) measures were as precise as theta(IRT) measures. CONCLUSION: Body part-specific simulated CATs were efficient and produced precise measures of FS with good discriminant validity. %B Journal of Clinical Epidemiology %V 58 %P 629-38 %G eng %M 15878477 %0 Generic %D 2004 %T The AMC Linear Disability Score project in a population requiring residential care: psychometric properties %A Holman, R. %A Lindeboom, R. %A Vermeulen, M. %A de Haan, R. J. %K *Disability Evaluation %K *Health Status Indicators %K Activities of Daily Living/*classification %K Adult %K Aged %K Aged, 80 and over %K Data Collection/methods %K Female %K Humans %K Logistic Models %K Male %K Middle Aged %K Netherlands %K Pilot Projects %K Probability %K Psychometrics/*instrumentation %K Questionnaires/standards %K Residential Facilities/*utilization %K Severity of Illness Index %X BACKGROUND: Currently there is a lot of interest in the flexible framework offered by item banks for measuring patient relevant outcomes, including functional status. However, there are few item banks, which have been developed to quantify functional status, as expressed by the ability to perform activities of daily life. METHOD: This paper examines the psychometric properties of the AMC Linear Disability Score (ALDS) project item bank using an item response theory model and full information factor analysis. Data were collected from 555 respondents on a total of 160 items. RESULTS: Following the analysis, 79 items remained in the item bank. The remaining 81 items were excluded because of: difficulties in presentation (1 item); low levels of variation in response pattern (28 items); significant differences in measurement characteristics for males and females or for respondents under or over 85 years old (26 items); or lack of model fit to the data at item level (26 items). CONCLUSIONS: It is conceivable that the item bank will have different measurement characteristics for other patient or demographic populations. However, these results indicate that the ALDS item bank has sound psychometric properties for respondents in residential care settings and could form a stable base for measuring functional status in a range of situations, including the implementation of computerised adaptive testing of functional status. %B Health and Quality of Life Outcomes %7 2004/08/05 %V 2 %P 42 %8 Aug 3 %@ 1477-7525 (Electronic)1477-7525 (Linking) %G eng %M 15291958 %2 514531 %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 %0 Journal Article %J Archives of Physical Medicine and Rehabilitation %D 2002 %T Development of an index of physical functional health status in rehabilitation %A Hart, D. L. %A Wright, B. D. %K *Health Status Indicators %K *Rehabilitation Centers %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Female %K Health Surveys %K Humans %K Male %K Middle Aged %K Musculoskeletal Diseases/*physiopathology/*rehabilitation %K Nervous System Diseases/*physiopathology/*rehabilitation %K Physical Fitness/*physiology %K Recovery of Function/physiology %K Reproducibility of Results %K Retrospective Studies %X OBJECTIVE: To describe (1) the development of an index of physical functional health status (FHS) and (2) its hierarchical structure, unidimensionality, reproducibility of item calibrations, and practical application. DESIGN: Rasch analysis of existing data sets. SETTING: A total of 715 acute, orthopedic outpatient centers and 62 long-term care facilities in 41 states participating with Focus On Therapeutic Outcomes, Inc. PATIENTS: A convenience sample of 92,343 patients (40% male; mean age +/- standard deviation [SD], 48+/-17y; range, 14-99y) seeking rehabilitation between 1993 and 1999. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patients completed self-report health status surveys at admission and discharge. The Medical Outcomes Study 36-Item Short-Form Health Survey's physical functioning scale (PF-10) is the foundation of the physical FHS. The Oswestry Low Back Pain Disability Questionnaire, Neck Disability Index, Lysholm Knee Questionnaire, items pertinent to patients with upper-extremity impairments, and items pertinent to patients with more involved neuromusculoskeletal impairments were cocalibrated into the PF-10. RESULTS: The final FHS item bank contained 36 items (patient separation, 2.3; root mean square measurement error, 5.9; mean square +/- SD infit, 0.9+/-0.5; outfit, 0.9+/-0.9). Analyses supported empirical item hierarchy, unidimensionality, reproducibility of item calibrations, and content and construct validity of the FHS-36. CONCLUSIONS: Results support the reliability and validity of FHS-36 measures in the present sample. Analyses show the potential for a dynamic, computer-controlled, adaptive survey for FHS assessment applicable for group analysis and clinical decision making for individual patients. %B Archives of Physical Medicine and Rehabilitation %V 83 %P 655-65 %8 May %G eng %M 11994805