Performance of an item response theory-based computer adaptive test in identifying functional decline

Area of Science:

• Rehabilitation medicine
• Psychometrics
• Oncology

Background:

• Functional status measurement in advanced lung cancer is crucial for patient care.
• Traditional assessments can impose a significant burden on patients.
• Item response theory-based computer adaptive tests (CAT) offer a potential solution for efficient functional measurement.

Purpose of the Study:

• To evaluate the respondent burden and responsiveness of the Activity Measure for Post-Acute Care computer adaptive test (AM-PAC-CAT).
• To assess the utility of AM-PAC-CAT in patients with late-stage lung cancer.

Main Methods:

• A two-year prospective cohort study involving 311 patients with late-stage lung cancer.
• Monthly telephonic assessments using AM-PAC-CAT, symptom scales, and a global rating of change (GRC).
• Anchor-based and distribution-based methods (SES, SRM) were used to determine responsiveness.

Main Results:

• AM-PAC-CAT administration averaged 112 seconds, demonstrating a low respondent burden.
• AM-PAC-CAT scores showed expected changes correlating with GRC responses and clinical events.
• Standardized effect size and standardized response mean indicated moderate responsiveness, particularly in the months preceding death.

Conclusions:

• The AM-PAC-CAT is a low-burden (<2-minute) functional measurement tool.
• Both anchor-based and distribution-based analyses suggest moderate responsiveness in late-stage lung cancer patients.
• AM-PAC-CAT is a viable and efficient tool for assessing functional status in this population.