Quality of Life Research

, Volume 18, Issue 3, pp 359–370 | Cite as

Measuring global physical health in children with cerebral palsy: illustration of a multidimensional bi-factor model and computerized adaptive testing

  • Stephen M. Haley
  • Pengsheng Ni
  • Helene M. Dumas
  • Maria A. Fragala-Pinkham
  • Ronald K. Hambleton
  • Kathleen Montpetit
  • Nathalie Bilodeau
  • George E. Gorton
  • Kyle Watson
  • Carole A. Tucker



The purposes of this study were to apply a bi-factor model for the determination of test dimensionality and a multidimensional CAT using computer simulations of real data for the assessment of a new global physical health measure for children with cerebral palsy (CP).


Parent respondents of 306 children with cerebral palsy were recruited from four pediatric rehabilitation hospitals and outpatient clinics. We compared confirmatory factor analysis results across four models: (1) one-factor unidimensional; (2) two-factor multidimensional (MIRT); (3) bi-factor MIRT with fixed slopes; and (4) bi-factor MIRT with varied slopes. We tested whether the general and content (fatigue and pain) person score estimates could discriminate across severity and types of CP, and whether score estimates from a simulated CAT were similar to estimates based on the total item bank, and whether they correlated as expected with external measures.


Confirmatory factor analysis suggested separate pain and fatigue sub-factors; all 37 items were retained in the analyses. From the bi-factor MIRT model with fixed slopes, the full item bank scores discriminated across levels of severity and types of CP, and compared favorably to external instruments. CAT scores based on 10- and 15-item versions accurately captured the global physical health scores.


The bi-factor MIRT CAT application, especially the 10- and 15-item versions, yielded accurate global physical health scores that discriminated across known severity groups and types of CP, and correlated as expected with concurrent measures. The CATs have potential for collecting complex data on the physical health of children with CP in an efficient manner.


Bi-factor model Computerized adaptive testing Item response theory 



Supported by the Shriners Hospital for Children Foundation (Grant # 8957) and an Independent Scientist award to Dr. Haley (National Center on Medical Rehabilitation Research/NICHD/NIH, grant # K02 HD45354-01A1).


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Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Stephen M. Haley
    • 1
  • Pengsheng Ni
    • 1
  • Helene M. Dumas
    • 2
  • Maria A. Fragala-Pinkham
    • 2
  • Ronald K. Hambleton
    • 3
  • Kathleen Montpetit
    • 4
  • Nathalie Bilodeau
    • 4
  • George E. Gorton
    • 5
  • Kyle Watson
    • 6
  • Carole A. Tucker
    • 7
  1. 1.Health and Disability Research InstituteBoston University School of Public HealthBostonUSA
  2. 2.Research Center for Children with Special Health Care NeedsFranciscan Hospital for ChildrenBostonUSA
  3. 3.Department of Educational Policy, Research and Administration, Center for Educational AssessmentUniversity of MassachusettsAmherstUSA
  4. 4.Department of Occupational TherapyShriners Hospital for ChildrenMontrealCanada
  5. 5.Motion LabShriners Hospital for ChildrenSpringfieldUSA
  6. 6.Motion Analysis LabShriners Hospital for ChildrenPhiladelphiaUSA
  7. 7.Physical Therapy Department, College of Health ProfessionsTemple UniversityPhiladelphiaUSA

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