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Measuring physical function in patients with complex medical and postsurgical conditions: a computer adaptive
Hilary Siebens1, Patricia L Andres, Ni Pengsheng
1Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA.
American Journal of Physical Medicine & Rehabilitation
|October 6, 2005
Summary
The Activity Measure--Post-Acute Care (AM-PAC) effectively assesses function in complex medical patients. Computer adaptive testing (CAT) provides valid scores using fewer questions, improving rehabilitation efficiency.
Area of Science:
- Rehabilitation Medicine
- Health Outcomes Measurement
- Psychometrics
Background:
- Assessing functional status is crucial for rehabilitation outcomes in medically complex and postsurgical patients.
- Current assessment tools may not fully capture the diverse range of disabilities in these populations.
- The need for efficient and valid measurement tools in post-acute care is increasing.
Purpose of the Study:
- To evaluate if the Activity Measure--Post-Acute Care (AM-PAC) adequately samples the disability spectrum in medically complex and postsurgical rehabilitation patients.
- To determine if computer adaptive testing (CAT) can generate accurate patient scores with a reduced number of questions.
Main Methods:
- An observational study involving 158 subjects undergoing rehabilitation in inpatient and community settings.
- Data collected through interviewer-administered activity questions, SF-36, and standardized chart items (FIM, OASIS, MDS).
- Rasch modeling was used to analyze item and person parameters; CAT assessed score accuracy with fewer items.
Main Results:
- The 163-item AM-PAC pool comprehensively covers physical, personal, and instrumental activities.
- CAT analysis demonstrated that using only 10 items yielded comparable scores to using the entire item pool.
- Patient ability estimates correlated well with average item difficulty.
Conclusions:
- The AM-PAC is a suitable tool for assessing functional abilities across a wide range of patients with complex medical conditions.
- Computer adaptive testing (CAT) significantly reduces the number of questions required to obtain valid patient scores, enhancing assessment efficiency.