A computerized adaptive test for patients with shoulder impairments produced responsive measures of function

Area of Science:

• Orthopedics
• Rehabilitation Medicine
• Health Outcomes Research

Background:

• Computerized adaptive tests (CATs) offer efficient data collection with minimal loss of measurement precision.
• The administrative efficiency, sensitivity to change, and responsiveness of shoulder CAT-based functional status (CAT-FS) measures have not been previously evaluated.
• This study addresses these gaps by assessing the shoulder CAT.

Purpose of the Study:

• To evaluate the efficiency and responsiveness of the shoulder CAT.
• To assess the precision, sensitivity to change, and responsiveness of CAT-FS measures in patients with shoulder impairments.

Main Methods:

• A secondary analysis was conducted on prospectively collected data from 30,987 patients with shoulder impairments undergoing outpatient rehabilitation.
• Patients completed the shoulder CAT at intake, with 13,805 (45% completion rate) also completing it at discharge.
• Efficiency of CAT administration and responsiveness of CAT-FS measures were evaluated.

Main Results:

• Patients answered an average of 6 CAT items in approximately 1.5 minutes, yielding precise CAT-FS estimates.
• The CAT-FS measures demonstrated negligible floor and minimal ceiling effects, with 94% of scores between 20 and 80.
• Seventy-nine percent of patients showed changes greater than minimal detectable change, and 76% exceeded minimal clinically important improvement.

Conclusions:

• The shoulder CAT demonstrated efficiency in data collection.
• CAT-FS measures proved to be precise, sensitive to change, and responsive.
• Future research should aim for more complete data to mitigate potential patient selection bias from secondary analysis.