%0 Journal Article %J Journal of Pain %D 2009 %T Development and preliminary testing of a computerized adaptive assessment of chronic pain %A Anatchkova, M. D. %A Saris-Baglama, R. N. %A Kosinski, M. %A Bjorner, J. B. %K *Computers %K *Questionnaires %K Activities of Daily Living %K Adaptation, Psychological %K Chronic Disease %K Cohort Studies %K Disability Evaluation %K Female %K Humans %K Male %K Middle Aged %K Models, Psychological %K Outcome Assessment (Health Care) %K Pain Measurement/*methods %K Pain, Intractable/*diagnosis/psychology %K Psychometrics %K Quality of Life %K User-Computer Interface %X The aim of this article is to report the development and preliminary testing of a prototype computerized adaptive test of chronic pain (CHRONIC PAIN-CAT) conducted in 2 stages: (1) evaluation of various item selection and stopping rules through real data-simulated administrations of CHRONIC PAIN-CAT; (2) a feasibility study of the actual prototype CHRONIC PAIN-CAT assessment system conducted in a pilot sample. Item calibrations developed from a US general population sample (N = 782) were used to program a pain severity and impact item bank (kappa = 45), and real data simulations were conducted to determine a CAT stopping rule. The CHRONIC PAIN-CAT was programmed on a tablet PC using QualityMetric's Dynamic Health Assessment (DYHNA) software and administered to a clinical sample of pain sufferers (n = 100). The CAT was completed in significantly less time than the static (full item bank) assessment (P < .001). On average, 5.6 items were dynamically administered by CAT to achieve a precise score. Scores estimated from the 2 assessments were highly correlated (r = .89), and both assessments discriminated across pain severity levels (P < .001, RV = .95). Patients' evaluations of the CHRONIC PAIN-CAT were favorable. PERSPECTIVE: This report demonstrates that the CHRONIC PAIN-CAT is feasible for administration in a clinic. The application has the potential to improve pain assessment and help clinicians manage chronic pain. %B Journal of Pain %7 2009/07/15 %V 10 %P 932-943 %8 Sep %@ 1528-8447 (Electronic)1526-5900 (Linking) %G eng %M 19595636 %2 2763618 %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 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 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 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 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 Journal Article %J Medical Care %D 2000 %T Item response theory and health outcomes measurement in the 21st century %A Hays, R. D. %A Morales, L. S. %A Reise, S. P. %K *Models, Statistical %K Activities of Daily Living %K Data Interpretation, Statistical %K Health Services Research/*methods %K Health Surveys %K Human %K Mathematical Computing %K Outcome Assessment (Health Care)/*methods %K Research Design %K Support, Non-U.S. Gov't %K Support, U.S. Gov't, P.H.S. %K United States %X Item response theory (IRT) has a number of potential advantages over classical test theory in assessing self-reported health outcomes. IRT models yield invariant item and latent trait estimates (within a linear transformation), standard errors conditional on trait level, and trait estimates anchored to item content. IRT also facilitates evaluation of differential item functioning, inclusion of items with different response formats in the same scale, and assessment of person fit and is ideally suited for implementing computer adaptive testing. Finally, IRT methods can be helpful in developing better health outcome measures and in assessing change over time. These issues are reviewed, along with a discussion of some of the methodological and practical challenges in applying IRT methods. %B Medical Care %V 38 %P II28-II42 %G eng %M 10982088 %0 Journal Article %J Journal of Outcomes Measurement %D 1997 %T On-line performance assessment using rating scales %A Stahl, J. %A Shumway, R. %A Bergstrom, B. %A Fisher, A. %K *Outcome Assessment (Health Care) %K *Rehabilitation %K *Software %K *Task Performance and Analysis %K Activities of Daily Living %K Humans %K Microcomputers %K Psychometrics %K Psychomotor Performance %X The purpose of this paper is to report on the development of the on-line performance assessment instrument--the Assessment of Motor and Process Skills (AMPS). Issues that will be addressed in the paper include: (a) the establishment of the scoring rubric and its implementation in an extended Rasch model, (b) training of raters, (c) validation of the scoring rubric and procedures for monitoring the internal consistency of raters, and (d) technological implementation of the assessment instrument in a computerized program. %B Journal of Outcomes Measurement %V 1 %P 173-191 %G eng %M 9661720