%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 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 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 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 J Outcome Meas %D 1998 %T The effect of item pool restriction on the precision of ability measurement for a Rasch-based CAT: comparisons to traditional fixed length examinations %A Halkitis, P. N. %K *Decision Making, Computer-Assisted %K Comparative Study %K Computer Simulation %K Education, Nursing %K Educational Measurement/*methods %K Human %K Models, Statistical %K Psychometrics/*methods %X This paper describes a method for examining the precision of a computerized adaptive test with a limited item pool. Standard errors of measurement ascertained in the testing of simulees with a CAT using a restricted pool were compared to the results obtained in a live paper-and-pencil achievement testing of 4494 nursing students on four versions of an examination of calculations of drug administration. CAT measures of precision were considered when the simulated examine pools were uniform and normal. Precision indices were also considered in terms of the number of CAT items required to reach the precision of the traditional tests. Results suggest that regardless of the size of the item pool, CAT provides greater precision in measurement with a smaller number of items administered even when the choice of items is limited but fails to achieve equiprecision along the entire ability continuum. %B J Outcome Meas %V 2 %P 97-122 %G eng %M 9661734