%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 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 Quality of Life Research %D 2003 %T Calibration of an item pool for assessing the burden of headaches: an application of item response theory to the Headache Impact Test (HIT) %A Bjorner, J. B. %A Kosinski, M. %A Ware, J. E., Jr. %K *Cost of Illness %K *Decision Support Techniques %K *Sickness Impact Profile %K Adolescent %K Adult %K Aged %K Comparative Study %K Disability Evaluation %K Factor Analysis, Statistical %K Headache/*psychology %K Health Surveys %K Human %K Longitudinal Studies %K Middle Aged %K Migraine/psychology %K Models, Psychological %K Psychometrics/*methods %K Quality of Life/*psychology %K Software %K Support, Non-U.S. Gov't %X BACKGROUND: Measurement of headache impact is important in clinical trials, case detection, and the clinical monitoring of patients. Computerized adaptive testing (CAT) of headache impact has potential advantages over traditional fixed-length tests in terms of precision, relevance, real-time quality control and flexibility. OBJECTIVE: To develop an item pool that can be used for a computerized adaptive test of headache impact. METHODS: We analyzed responses to four well-known tests of headache impact from a population-based sample of recent headache sufferers (n = 1016). We used confirmatory factor analysis for categorical data and analyses based on item response theory (IRT). RESULTS: In factor analyses, we found very high correlations between the factors hypothesized by the original test constructers, both within and between the original questionnaires. These results suggest that a single score of headache impact is sufficient. We established a pool of 47 items which fitted the generalized partial credit IRT model. By simulating a computerized adaptive health test we showed that an adaptive test of only five items had a very high concordance with the score based on all items and that different worst-case item selection scenarios did not lead to bias. CONCLUSION: We have established a headache impact item pool that can be used in CAT of headache impact. %B Quality of Life Research %V 12 %P 913-933 %G eng %M 14661767 %0 Journal Article %J Quality of Life Research %D 2003 %T The feasibility of applying item response theory to measures of migraine impact: a re-analysis of three clinical studies %A Bjorner, J. B. %A Kosinski, M. %A Ware, J. E., Jr. %K *Sickness Impact Profile %K Adolescent %K Adult %K Aged %K Comparative Study %K Cost of Illness %K Factor Analysis, Statistical %K Feasibility Studies %K Female %K Human %K Male %K Middle Aged %K Migraine/*psychology %K Models, Psychological %K Psychometrics/instrumentation/*methods %K Quality of Life/*psychology %K Questionnaires %K Support, Non-U.S. Gov't %X BACKGROUND: Item response theory (IRT) is a powerful framework for analyzing multiitem scales and is central to the implementation of computerized adaptive testing. OBJECTIVES: To explain the use of IRT to examine measurement properties and to apply IRT to a questionnaire for measuring migraine impact--the Migraine Specific Questionnaire (MSQ). METHODS: Data from three clinical studies that employed the MSQ-version 1 were analyzed by confirmatory factor analysis for categorical data and by IRT modeling. RESULTS: Confirmatory factor analyses showed very high correlations between the factors hypothesized by the original test constructions. Further, high item loadings on one common factor suggest that migraine impact may be adequately assessed by only one score. IRT analyses of the MSQ were feasible and provided several suggestions as to how to improve the items and in particular the response choices. Out of 15 items, 13 showed adequate fit to the IRT model. In general, IRT scores were strongly associated with the scores proposed by the original test developers and with the total item sum score. Analysis of response consistency showed that more than 90% of the patients answered consistently according to a unidimensional IRT model. For the remaining patients, scores on the dimension of emotional function were less strongly related to the overall IRT scores that mainly reflected role limitations. Such response patterns can be detected easily using response consistency indices. Analysis of test precision across score levels revealed that the MSQ was most precise at one standard deviation worse than the mean impact level for migraine patients that are not in treatment. Thus, gains in test precision can be achieved by developing items aimed at less severe levels of migraine impact. CONCLUSIONS: IRT proved useful for analyzing the MSQ. The approach warrants further testing in a more comprehensive item pool for headache impact that would enable computerized adaptive testing. %B Quality of Life Research %V 12 %P 887-902 %G eng %M 14661765 %0 Journal Article %J Assessment %D 2000 %T Computerization and adaptive administration of the NEO PI-R %A Reise, S. P. %A Henson, J. M. %K *Personality Inventory %K Algorithms %K California %K Diagnosis, Computer-Assisted/*methods %K Humans %K Models, Psychological %K Psychometrics/methods %K Reproducibility of Results %X This study asks, how well does an item response theory (IRT) based computerized adaptive NEO PI-R work? To explore this question, real-data simulations (N = 1,059) were used to evaluate a maximum information item selection computerized adaptive test (CAT) algorithm. Findings indicated satisfactory recovery of full-scale facet scores with the administration of around four items per facet scale. Thus, the NEO PI-R could be reduced in half with little loss in precision by CAT administration. However, results also indicated that the CAT algorithm was not necessary. We found that for many scales, administering the "best" four items per facet scale would have produced similar results. In the conclusion, we discuss the future of computerized personality assessment and describe the role IRT methods might play in such assessments. %B Assessment %V 7 %P 347-64 %G eng %M 11151961