%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 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 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 Medical Teacher %D 2004 %T A computerized adaptive knowledge test as an assessment tool in general practice: a pilot study %A Roex, A. %A Degryse, J. %K *Computer Systems %K Algorithms %K Educational Measurement/*methods %K Family Practice/*education %K Humans %K Pilot Projects %X Advantageous to assessment in many fields, CAT (computerized adaptive testing) use in general practice has been scarce. In adapting CAT to general practice, the basic assumptions of item response theory and the case specificity must be taken into account. In this context, this study first evaluated the feasibility of converting written extended matching tests into CAT. Second, it questioned the content validity of CAT. A stratified sample of students was invited to participate in the pilot study. The items used in this test, together with their parameters, originated from the written test. The detailed test paths of the students were retained and analysed thoroughly. Using the predefined pass-fail standard, one student failed the test. There was a positive correlation between the number of items and the candidate's ability level. The majority of students were presented with questions in seven of the 10 existing domains. Although proved to be a feasible test format, CAT cannot substitute for the existing high-stakes large-scale written test. It may provide a reliable instrument for identifying candidates who are at risk of failing in the written test. %B Medical Teacher %V 26 %P 178-83 %8 Mar %G eng %M 15203528