Quality of Life Research

, Volume 18, Issue 4, pp 461–471

Replenishing a computerized adaptive test of patient-reported daily activity functioning

  • Stephen M. Haley
  • Pengsheng Ni
  • Alan M. Jette
  • Wei Tao
  • Richard Moed
  • Doug Meyers
  • Larry H. Ludlow
Article

DOI: 10.1007/s11136-009-9463-5

Cite this article as:
Haley, S.M., Ni, P., Jette, A.M. et al. Qual Life Res (2009) 18: 461. doi:10.1007/s11136-009-9463-5

Abstract

Purpose

Computerized adaptive testing (CAT) item banks may need to be updated, but before new items can be added, they must be linked to the previous CAT. The purpose of this study was to evaluate 41 pretest items prior to including them into an operational CAT.

Methods

We recruited 6,882 patients with spine, lower extremity, upper extremity, and nonorthopedic impairments who received outpatient rehabilitation in one of 147 clinics across 13 states of the USA. Forty-one new Daily Activity (DA) items were administered along with the Activity Measure for Post-Acute Care Daily Activity CAT (DA-CAT-1) in five separate waves. We compared the scoring consistency with the full item bank, test information function (TIF), person standard errors (SEs), and content range of the DA-CAT-1 to the new CAT (DA-CAT-2) with the pretest items by real data simulations.

Results

We retained 29 of the 41 pretest items. Scores from the DA-CAT-2 were more consistent (ICC = 0.90 versus 0.96) than DA-CAT-1 when compared with the full item bank. TIF and person SEs were improved for persons with higher levels of DA functioning, and ceiling effects were reduced from 16.1% to 6.1%.

Conclusions

Item response theory and online calibration methods were valuable in improving the DA-CAT.

Keywords

Outcomes assessment Quality of life Item response theory Activities of daily living (ADL) 

Abbreviations

ADL

Activities of daily living

AM-PAC

Activity Measure for Post-Acute Care

CAT

Computerized adaptive testing

CFA

Confirmatory factor analyses

CFI

Comparative fit index

DA-CAT-1

Original Daily Activity item bank in the CAT

DA-CAT-2

New expanded item bank with pretest items in the new CAT version

DIF

Differential item functioning

GPCM

Generalized partial credit model

ICC

Intraclass correlation coefficient

IRT

Item response theory

PRO

Patient-reported outcome

RMSEA

Root-mean-square error of approximation

SE

Standard errors

TIF

Test information function

TLI

Tucker–Lewis index

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Stephen M. Haley
    • 1
  • Pengsheng Ni
    • 1
  • Alan M. Jette
    • 1
  • Wei Tao
    • 2
  • Richard Moed
    • 3
  • Doug Meyers
    • 4
  • Larry H. Ludlow
    • 5
  1. 1.Boston University School of Public HealthBostonUSA
  2. 2.ACT, Inc.Iowa CityUSA
  3. 3.CREcare, LLCGilfordUSA
  4. 4.Meyers Healthcare SolutionsApopkaUSA
  5. 5.Department of Educational Research, Measurement and EvaluationBoston CollegeBostonUSA

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