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Computerized Adaptive Testing System of Functional Assessment of Stroke

Computerized Adaptive Testing System of Functional Assessment of Stroke

Published on: January 7, 2019

Improving patient reported outcomes using item response theory and computerized adaptive testing.

Eliza F Chakravarty¹, Jakob B Bjorner, James F Fries

¹Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA.

The Journal of Rheumatology

|June 7, 2007

Summary

This study enhances patient-reported outcomes (PRO) using item response theory (IRT) and computerized adaptive testing (CAT). These methods improve measurement precision and reduce patient burden in rheumatology research.

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Area of Science:

Rheumatology
Psychometrics
Health Outcomes Research

Background:

Patient-reported outcomes (PRO) are crucial in rheumatology clinical trials and observational studies.
Current PRO instruments require evaluation and refinement for enhanced measurement precision.
Item response theory (IRT) and computerized adaptive testing (CAT) offer advanced statistical approaches for PRO development.

Framework:

Developed a domain hierarchy for physical function/disability, from general to specific.
Established a structured item evaluation process involving trained raters, expert consensus, and patient input.
Utilized IRT for in-depth analysis of item response functions and measurement precision.

Implementation:

Created a refined data bank of PRO items for physical function/disability.
Physical function/disability domain includes upper extremity, trunk, lower extremity, and complex activities subdomains.
Consensus favored present-tense "capability" questions over past-tense "performance" items, using a 4- or 5-item Likert response.

Implications:

IRT and CAT can optimize existing PRO instruments, reducing patient burden.
Enhanced measurement precision can lead to more accurate assessments of physical function/disability.
Improved PROs may decrease sample size requirements for clinical trials, reducing costs.